The methadone industry added 254 new clinics between 2014 and 2018

While Congress and the Trump administration advocated greater use of buprenorphine, a drug against drug addiction, to stem the opioid epidemic, a handful of states were allowing new treatment clinics at the same time. methadone in dozens of communities among the hardest hit in the country.

The methadone treatment industry, which began in the late 1960s, has seen more growth over the last four years than in the last two decades, said Mark Parrino, president. of the American Association for the Treatment of Opioid Dependence, which represents providers of methadone treatment.

Between 2014 and 2018, the methadone sector added 254 new clinics, according to data from the Drug Enforcement Administration. In the past two decades, the increase in the number of programs has been only gradual, said Parrino. "We have not seen such dramatic growth in this sector since the 1970s."

Despite a national pace for more scientific treatment of people addicted to analgesics, heroin, and other illicit opioids, the extension of methadone clinics was almost never ignored.

Unlike buprenorphine, which can be prescribed by specially licensed and orally administered practitioners at home, or injectable Vivitrol, which can be given by any doctor, methadone should be dispensed daily in clinics. highly regulated and often highly visible.

Cluttered parking lots, long queues and the potential for drug diversion have led many states to limit the number of clinics they allow.

Some politicians and many members of the general public have compared methadone treatment with negotiating one addiction for another. And some politicians – including former New York Mayor Rudy Giuliani, a Republican, and the former Vermont Governor and Democratic presidential candidate, Howard Dean – have criticized the use of this drug .

It's starting to change.

"There has been a stigma underlying methadone for so many years that the industry remains naturally unobtrusive," said Yngvild Olsen, a drug addiction physician in Baltimore and a member of the board of directors. of the American Society of Addiction Medicine. "Even now," she said, "access to methadone is very geographic, depending on where you live."

Faced with an epidemic of opioids that kills more than 130 Americans every day, more and more states, including those whose expansion of methadone treatment was previously limited, ask for more information. Industry to implement new programs in rural and suburban areas affected by opioids and lacking adequate medicines. assisted treatment options.

And opioid processing companies are responding, with most new clinics offering all three opioid-dependence drugs approved by the Food and Drug Administration. The recent surplus is mainly due to millions of dollars in new Medicaid reimbursements for methadone treatment in at least 37 states and in the District of Columbia.

Indiana, Maryland and New York have been among the most aggressive states in search of an expansion of methadone treatment. Over the last two years, they have strategically implemented dozens of new facilities in rural and suburban communities. Ohio and Florida are planning major expansions this year and next.

At the same time, the laws and regulations of at least six other states – Georgia, Indiana, Louisiana, Mississippi, West Virginia and Wyoming – still restrict licensing for new methadone clinics, even though opioid-dependent people too far from the nearest methadone clinic to commute.

Reimbursement for methadone treatment has begun to be available in the last four years in many of the 33 states and the District of Columbia where Medicaid was expanded under the Affordable Care for Low-Income Adult Act. As a result, the opioid processing industry is financially incentivized to invest in new facilities.

In January 2020, Medicare coverage for methadone treatment for people 65 years of age and older is expected to begin under the recently adopted opioid seizure law, which will further increase the potential incomes of people living with the drug. providers of opioid treatments.

Methadone and buprenorphine are opioids that, if administered orally, eliminate withdrawal symptoms and cravings without causing euphoria in people who stop prescription painkillers and heroines.

Vivitrol, a 30-day injection, blocks the effects of opioids and alcohol and is not a narcotic. With less research on its results, the relatively new drug is considered effective only for some people.

The American Society of Addiction Medicine recommends that all three drugs be considered by all patients seeking treatment for opioid dependence in order to determine which one will work best.

For many, only methadone will provide sufficient relief for drug cravings, especially those who have used high doses of heroin for many years and those who have used fentanyl, a more potent synthetic opioid. For others, buprenorphine or Vivitrol may be the best choice.

To open a methadone clinic, companies and non-profit groups must apply for a state license after they have demonstrated the need for this service. "It's entirely up to states to determine if they have sufficient opioid processing capacity," said Parrino.

Most clinics were created with public funds from the 1970s, when a heroin epidemic ravaged large urban centers. Others have been added over the past two decades, especially in small towns, while the opioid epidemic has spread to rural and suburban communities.

Once a state has issued a license and the location of an establishment is approved under local zoning orders, companies must obtain federal government approval with the DEA and the Administration of Psychoactive Substance Abuse and Mental Health Services and follow strict rules.

For example, methadone is usually delivered through a plexiglass shield and stored overnight in locked containers. And patients are routinely screened to make sure that they take the drug and do not combine it with other dangerous drugs.

Most methadone patients go to a clinic every day to take their medication, under the supervision of a professional. They are also encouraged to attend individual and group psychosocial counseling sessions. Once stabilized, some patients may take doses at home on weekends, often switching to weekly and monthly dosing at home.

As of October, 1,611 methadone treatment programs were underway in 49 states and in the District of Columbia, serving more than 380,000 patients, as reported by the Addiction Services Administration. and mental health. And that number is expected to increase over the next two years.

Buprenorphine, which was developed with federal funding and approved by the FDA in 2002, can be prescribed by doctors, nurse practitioners and medical assistants for 30 days, supported by a pharmacy and taken at home. Similar to those taking methadone, patients taking buprenorphine are encouraged to attend individual and group counseling sessions.

Although the federal government has spent millions of dollars supporting a larger prescription for buprenorphine, particularly by primary care physicians, the number of prescribers who have taken the mandatory eight-hour AED course and the number of patients they are much more important. lower than expected.

According to the Addiction and Mental Health Services Administration, approximately 56,000 of the more than one million doctors in the country are allowed to prescribe buprenorphine for opioid dependence, but only 112,000 patients received the drug latest.

Buprenorphine is largely diverted and sought after on the black market, particularly among active opioid consumers who sometimes wish to refrain from illicit drug use and avoid withdrawal symptoms. Proponents of a larger prescription for drugs argue that most diversions of buprenorphine result from limited access to the drug by legitimate means.

Unlike methadone and buprenorphine, Vivitrol is not a narcotic and is not diverted. So far, 23,000 people are taking Vivitrol for opioid addiction, according to the Addiction and Mental Health Services Administration. Vivitrol is a long-acting injectable medicine that has been approved by the FDA in 2010 and can be prescribed and administered by any doctor without special permission.

Research shows that people on methadone, buprenorphine or Vivitrol are at least twice as likely to stay on treatment and recover in the long term as those on untreated treatment.

Despite scientific evidence, fewer than 1 in 10 people with opioid addiction receive treatment for this addiction that includes these medications. About the same number of people are receiving drug treatment without medication, often because no one is available in their community.

And those who want to quit are often unable to find treatment in their community or can not afford it.

"There is no doubt that better access to methadone maintenance treatment would save lives," said Andrew Kolodny, co-director of research on opioid treatment at the University. Brandeis. "But for an epidemic of drug abuse that is disproportionate in rural and suburban areas, an intervention based on the number of people who visit a clinic every day is not the best option." Buprenorphine would be better, but its growth will not be fast enough. "