Access to Care for Methadone Maintenance Patients in the United States

Abstract

This policy commentary addresses a significant access to care issue that faces methadone maintenance patients seeking residential treatment in the United States. Methadone maintenance therapy (MMT) has demonstrated strong efficacy in the outpatient treatment of opiate dependence. However, many opiate dependent patients are also in need of more intensive interventions, such as residential care. Many publically-funded residential treatment programs explicitly decline to admit MMT patients, contending that methadone raises both clinical and administrative problems in treatment. Although advocates within the field believe that this issue is a violation of the American's with Disabilities Act (ADA) in the United States, no lawsuits have been brought forth, and there is no legal precedent or public policy to inform the debate. The present paper provides an overview of this problem and discusses factors that may contribute to the problem, including an abstinence-oriented philosophy and treatment program operational concerns. The paper also draws parallels between methadone and other medical conditions and analyzes the problem in the context of disabilities encompassed in the ADA. Finally, recommendations on strategies for increasing access to residential care for MMT patients are provided.

Only One In Twenty Justice-Referred Adults In Specialty Treatment For Opioid Use Receive Methadone Or Buprenorphine

“…For example, this underuse could be related to characteristics of the facilities that treat justice-involved people: Programs may be unwilling to incorporate these medications into their treatment protocols either because of operational concerns or because doing so would run counter to their abstinence-only philosophies. 36 Targeted efforts to enhance the capacity of treatment programs to administer medication treatment or connect patients with providers who will administer it, as well regulatory changes to require certified programs to allow and even encourage the use of agonist medications as standard treatment for opioid use disorder, could help significantly expand the number of people who receive these treatments. Certain health organizations, such as the Veterans Health Administration, have been found to have greater utilization rates of agonist treatment for clients who are and those who are not justice involved, 37 and these organizations could be used as examples for other programs seeking to increase access to the treatment.…”

Racial and ethnic differences in opioid agonist treatment for opioid use disorder in a U.S. national sample

“…While there is ample evidence supporting their use over non-medication abstinence-based therapies (Veilleux et al, 2010; Volkow et al, 2014; Connery, 2015), most programs do not offer opioid agonist treatment (OAT) (Knudsen et al, 2011). Medication-stigma along with regulatory barriers often preclude the incorporation of medication into traditional substance use care (Hettema and Sorensen, 2009; Olsen and Sharfstein, 2014). Patients seeking methadone often experience long waiting lists and have to travel long distances to access treatment (Rosenblum et al, 2011; Gryczynski et al, 2011), and buprenorphine, which is commonly prescribed by office-based providers, also remains largely inaccessible due to a shortage of certified providers (Duncan et al, 2015).…”

Perceived barriers to utilise methadone maintenance therapy among male injection drug users in rural areas of southern Thailand

“…Abstinence‐based treatment is instead believed to be the first course of action for younger drug users. The abstinence‐oriented philosophy was cited as a barrier from the service provider's perspective [39].…”