Methadone Treatment for
Opioid Use Disorder
Improving Access Through Regulatory and
Legal Change
__________
Improving Access Through Regulatory and
Legal Change
Lisa Bain, Sheena M. Posey Norris,
and Clare Stroud, Rapporteurs
Board on Health Sciences Policy
Board on Health Care Services
Health and Medicine Division
Action Collaborative on Countering the
U.S. Opioid Epidemic
Proceedings of a Workshop
NATIONAL ACADEMY OF MEDICINE
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
This activity was supported by a contract between the National Academy of Sciences and the Office of National Drug Control Policy, Executive Office of the President (11316021P0001OND). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-69096-6
International Standard Book Number-10: 0-309-69096-X
Digital Object Identifier: https://doi.org/10.17226/26635
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2022. Methadone treatment for opioid use disorder: Improving access through regulatory and legal change: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/26635.
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PLANNING COMMITTEE ON METHADONE TREATMENT FOR OPIOID USE DISORDER: EXAMINING FEDERAL REGULATIONS AND LAWS1
ALAN LESHNER (Chair), American Association for the Advancement of Science (Emeritus)
GAVIN BART, Hennepin County Medical Center; University of Minnesota
RICHARD BONNIE, University of Virginia
MAGDALENA CERDÁ, New York University
ABBY COULTER, Urban Survivors Union
BRIDGET DOOLING, George Washington University
SHERI DOYLE, The Pew Charitable Trusts
TRACIE GARDNER, Legal Action Center
HELENA HANSEN, University of California, Los Angeles
VAN INGRAM, Kentucky Office of Drug Control Policy
MATTHEW LAWRENCE, Emory University School of Law
GAIL MATTOX, Morehouse School of Medicine
JOSIAH “JODY” RICH, Brown University
DANIELLE RUSSELL, Sonoran Prevention Works
KENNETH STOLLER, Johns Hopkins University
JONATHAN H. WATANABE, University of California, Irvine School of Pharmacy & Pharmaceutical Sciences
Staff
CLARE STROUD, Senior Program Officer
SHEENA M. POSEY NORRIS, Program Officer
EDEN NELEMAN, Senior Program Assistant
ELIZABETH FINKELMAN, Senior Program Officer (until December 2021)
ALEXANDRA ANDRADA, Program Officer
AISHA SALMAN, Program Officer
NOAH DUFF, Associate Program Officer
ANDREW M. POPE, Senior Director, Board on Health Sciences Policy
SHARYL NASS, Senior Director, Board on Health Care Services
___________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
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Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by BRIAN STROM, Rutgers, The State
University of New Jersey. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteurs and the National Academies.
Contents
2 METHADONE TREATMENT: PERSONAL PERSPECTIVES
Sustained Recovery May Require Continued Methadone Treatment
The Need for a Patient-Centered Focus
3 THE HISTORY OF METHADONE AND BARRIERS TO ACCESS FOR DIFFERENT POPULATIONS
The Early Years of Methadone Maintenance Regulation and the Politics of Stigma and Racialization
Current Barriers to Access, Initiation, and Retention in Methadone Treatment
4 CURRENT FEDERAL PRIORITIES AND REGULATORY FLEXIBILITIES DURING THE COVID-19 PANDEMIC
Goals and Priorities of the Current Administration
Regulatory Change in the Wake of Necessity: Lessons Learned from COVID-19
Understanding the Disconnect between State and Federal Regulations
5 IMPROVING ACCESS TO QUALITY TREATMENT IN OPIOID TREATMENT PROGRAMS THROUGH REGULATORY INNOVATION
Federal Statutes and Regulations that Govern Opioid Treatment Programs
Pharmacy Dispensing as an Extension of OTPs
Mobile Medication Units—A Demonstration Project in New Jersey
OTPs as Hub Sites in Systemic Expansion
Other Strategies to Expand Access through OTPs Proposed by Individual Workshop Participants
Crosscutting Regulatory Issues that Impact Correctional Facilities and Other Institutions
Transitioning from Incarceration to the Community
A State Trial Court Perspective
Civil Rights Litigation to Enable Methadone Treatment in Institutions
International Models of Pharmacy-Based Dispensing
Innovative Models of Initiation under Existing Regulations—Inpatient and Outpatient Settings
Potential New Treatment Modalities and Settings that Could be Opened Up with Regulatory Changes
8 ENSURING EQUITABLE ACCESS TO METHADONE BY REMOVING CURRENT BARRIERS AND PROVIDING INCENTIVES
Regulatory Opportunities to Remove Current Barriers
Regulatory Incentives to Facilitate Access to Quality Treatment
9 FRAMEWORKS TO GUIDE THE ASSESSMENT OF LEGAL AND REGULATORY CHALLENGES
A Policy Analysis Framework to Support Health Policy Decisions
A Cost-Effectiveness Framework to Assess Potential Legal and Regulatory Changes
10 MOVING FORWARD: POTENTIAL CONCRETE LEGAL AND REGULATORY ACTIONS
Exploring Opportunities to Reform Methadone Treatment
Federal Administrative Pathways to Promote Access to Quality Methadone Treatment—Matthew Lawrence
Innovations in Methadone Medication for Opioid Use Disorder—A Scoping Review—Wes Williams
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