In 2021, a bipartisan group of U.S. congresspeople proposed a new bill: the Modernizing Opioid Treatment (MOTA) Act, designed to remove barriers to care and affect people in methadone treatment programs get the evidence-based care they need. The bill didn’t pass that legislative session but was reintroduced in 2023 and currently resides on the Senate agenda, with a good chance of becoming law in 2024.
One important part of MOTA is the provision that “Expert clinical discretion would determine the frequency of counseling and drug testing in patient care.” This demonstrates the commitment to the harm reduction approach to treating OUD. The contents of a treatment plan should be individualized, patient-centered, and the result of a dynamic and adaptable collaboration between the clinician and patient.
In this context, the goal of testing is to gauge progress and the effectiveness of the treatment plan, rather than punish someone for relapsing. In addition, the amount and frequency of counseling and therapy should support individual patient needs in the way that best helps them, rather than a series of mandated hoops to jump through in order to access a complete range of evidence-based care.
It’s important to note that a separate bill – the Opioid Treatment Access Act of 2022 – did pass both the House and Senate and is now the law of the land. That law relaxed some restrictions on methadone treatment, but many experts and treatment advocates assert that the new law did not go far enough and left significant barriers to medication-assisted treatment (MAT) in place, specifically those regulating methadone prescribing and dispensing.
What is Methadone Treatment?
Methadone treatment is part of a harm reduction approach to opioid addiction we mention above, called medication-assisted treatment (MAT). It’s the gold-standard treatment for people with opioid use disorder (OUD), alongside buprenorphine and naltrexone. Among these three medications for opioid use disorder (MOUD), methadone is the most effective for severe opioid addiction, although experts agree all three medications can be both life-changing and lifesaving.
However, studies show that fewer patients receive MOUD than need them. Consider these facts, published in the 2022 National Survey on Drug Use and Health (2022 NSDUH):
Medication-Assisted Treatment (MAT) for OUD
- Among all people over age 12, 8.9 million misused opioids
- 2.4 million received MAT
- Among all people of age 18, 8.5 million misused opioids
- 2.3 million over age 18 people who misused opioids received MAT for OUD
- Among adults over age 18, 5.3 million people had OUD, including people with heroin use disorder, prescription opioid use disorder, and other opioids
- 1.2 million people with OUD received treatment for OUD
These figures show that the gap between the number of people who need MAT and the number of people who received MAT for OUD is significant. It’s called the treatment gap. One primary goal of the MOTA is to reduce barriers to care and affect people in methadone treatment in the best way possible.
Although methadone was the first MOUD approved by the FDA, and has been in use since the late 1960s, it’s the most highly controlled MOUD in the U.S. today. Current federal guidelines around methadone treatment:
- Require patients to appear in-person to receive medication
- Restrict methadone dispensation to Opioid Treatment Programs (OTPs)
- Prevent take-home doses for the first 90 days of treatment
- Restrict the initiation of treatment to in-person visits with specifically licensed and trained physicians at OTPs only
Let’s take a look at how the MOTA can reduce these barriers to care and affect people in methadone treatment programs in positive ways.
How MOTA Will Change Methadone Treatment
In 2024, despite the move toward harm reduction and destigmatizing addiction treatment, federally licensed opioid treatment programs (OTPs) – the places people can initiate and receive methadone – operate in three out of every ten counties in the U.S., and the vast majority of those are in urban areas. For instance, there are six OTPs in the state of Nebraska, all in the Omaha/Lincoln areas. In Wyoming, there are no OTPs at all.
This creates problems for people who:
- Live in rural areas with no OTPs nearby
- Don’t have reliable transportation
- Have significant mobility issues
- Have problems reconciling a work schedule with daily med visits
The MOTA can address these barriers to care by:
- Expanding the number of doctors who can prescribe methadone
- Physicians licensed in addiction medicine may prescribe methadone without being associated with an OTP (2.644 Section 2.A subparagraph B.ii)
- Psychiatrists licensed addiction psychiatry may prescribe methadone without being associated with an OTP (2.644 Section 2.A subparagraph B.ii)
- Treatment may be initiated via telehealth (2.644 Section 2.A subparagraph G)
- Expanding the locations where people can access methadone
- (2.644 Section 2.A subparagraph C.i-iii)
Here’s how Congressman David Trone describes the pending legislation:
“In order to best fight the opioid epidemic in America, we have to meet folks where they are and ensure treatment is both affordable and accessible. MOTA does that by expanding treatment options for those [with] substance use disorder. With so many lives hanging in the balance, we must continue working together to develop innovative solutions to this crisis.”
Support From Addiction Treatment Professionals and Medical Academies
All cards on the table: not everyone is behind the changes in MOTA. One independent organization – the American Association for the Treatment of Opioid Dependence, Inc. – suggests the proposed changes are too lenient, suggesting the changes only increase access to medication, don’t have the proper safeguards, and aren’t evidence-based. It’s worth noting that none of the data in the information in that link was published after 2010.
It’s also worth noting that the Substance Abuse and Mental Health Services Administration (SAMHSA) studied these same changes when in place during the pandemic and found no evidence to suggest the proposed changes will increase harm, but rather, found ample evidence to suggest the changes will reduce harm for people with OUD. Based on those facts – publicly available here, here, here, and here – a total of 34 professional medical academies and advocacy organizations fully endorse the new legislation.
Organizations and Academies in Favor of MOTA
- Addiction Professionals of North Carolina
- AIDS United
- Alabama Society of Addiction Medicine
- American College of Academic Addiction Medicine (ACAAM)
- American Osteopathic Academy of Addiction Medicine
- American Society of Addiction Medicine (ASAM)
- Association for Multidisciplinary Education and Research in Substance Use and Addiction (AMERSA)
- Association of Virgin Islands Psychologists
- Behavioral Health Association of Providers
- California Consortium of Addiction Programs and Professionals
- Connecticut Certification Board
- End Substance Use Disorder
- Faces and Voices of Recovery
- Global Health Advocacy Incubator
- Grayken Center for Addiction at Boston Medical Center
- Hampshire HOPE
- Kennedy Forum
- Massachusetts Health and Hospital Association (MHA)
- Massachusetts Medical Society
- National Coalition to Liberate Methadone
- New Jersey Hospital Association
- New York Society of Addiction Medicine
- Northampton, Massachusetts Department of Health and Human Services
- Opioid Task Force of Franklin County and the North Quabbin Region (MA)
- Partnership to End Addiction
- Rhode Island Society of Addiction Medicine
- Shatterproof
- SMART Recovery
- Tapestry Health Systems Inc. (MA)
- The National Safety Council
- The Village Virgin Islands Partners in Recovery
- Young People in Recovery
- Virgin Islands Board of Pharmacy
- Oregon Society of Addiction Medicine
We’ll carefully review all sides of this debate. If the endorsement SAMHSA and these professional organizations offer influences congress to pass MOTA, then we’ll follow suit and expand access to the life-changing and lifesaving medication, methadone, while following all applicable rules and regulations established by federal, state, and local lawmakers.