Methadone Treatment for Opioid Use Disorder Improving Access Through Regulatory and Legal Change: Proceedings of a Workshop (2022) / Chapter Skim
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10 Moving Forward: Potential Concrete Legal and Regulatory Actions
10 Moving Forward: Potential Concrete Legal and Regulatory Actions
Pages 105-116
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From page 105... ...
. • Reforms most urgently needed include: extending take-home flexibilities, addressing coverage barriers, incentivizing states to expand methadone access, increasing flexibility at OTPs in prescribing and dispensing medications for OUD, allowing greater room for clinical discretion, and providing Americans with Disabilities Act enforcement guidance (Bonnie)
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From page 106... ...
They are not intended to reflect a consensus among workshop participants. The final session of the workshop aimed to review the presentations and discussions regarding potential legal and regulatory changes, as well as to seek reflections from people with a broad range of perspectives on the workshop discussions within a broader context of reforming drug policy and treatment for opioid use disorder (OUD)
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From page 107... ...
In particular, Bonnie said, "CMS should consider OTP [opioid treatment program] coverage in assessing Medicare Advantage network adequacy; should reevaluate and strengthen its risk adjustment model's application to substance use disorders; and should collect and scrutinize data on barriers in Medicaid managed care.
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From page 108... ...
Examples include relaxing take-home limitations, dosing requirements on methadone, and toxicology screening requirements. Using existing rulemaking authority to allow greater room for clinical discretion.
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From page 109... ...
Even with incremental improvements, she said, an insufficient number of OTPs exist to meet the needs of patients. Different models and new paradigms for delivery of methadone are needed, which could include a range of solutions discussed at this workshop: a hub-and-spoke model, with OTPs, FQHCs, and/or community behavioral health centers serving as hubs; and pharmacies, hospitals, primary care providers, correctional facilities, or other providers serving as spokes where patients can receive care and treatment.
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From page 110... ...
For example, she noted that there has been substantial research on the consequences of the COVID19 regulatory flexibilities, targeted research on the best way to approach illicitly manufactured fentanyl, and research on population-specific best practices. REFORMING METHADONE TREATMENT WITHIN THE BROADER CONTEXT FOR IMPROVING ACCESS TO MEDICATIONS FOR OPIOID USE DISORDER Individual workshop participants discussed several concrete next steps that could improve access to methadone, but would not require regulatory changes or new legislation.
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From page 111... ...
Redefining Success in Methadone Treatment As a person who has been on methadone maintenance for nearly 20 years, David Frank, medical sociologist at the New York University School of Global Public Health, has a unique perspective on the disconnect between the way methadone is administered and how it is actually used. Methadone enabled Frank to get a bank account, maintain a job, and eventually to earn a Ph.D., yet while he appears to be one of methadone's great success stories, he said he is not pursuing abstinence-based recovery and has never been compliant with the rules of his clinic.
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From page 112... ...
"That is what needs to change." Frank agreed, adding that the criminalization of methadone maintenance should be viewed in the context of the war on drugs and prohibition. Providing Methadone through a Hub-and-Spoke Model Vermont has established opioid treatment programs using a hub-andspoke model, said Brooklyn.
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From page 113... ...
However, several workshop participants with lived experience expressed deep concerns about the use of video-direct observed therapy. Integrating Opioid Treatment Fully into the Medical System In other fields of medicine, providers and researchers work collaboratively and there is constant peer review, said Brooklyn.
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From page 114... ...
Implementing the law will be challenging and will require funding from the state or opioid settlement money or other sources to enable implementation, said Cunningham. She added that they are also hoping to change the ability of skilled nursing facilities, residential treatment programs, and long-term care facilities to store and administer methadone.
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From page 115... ...
The top-down part, he said, relates to what the Office of National Drug Control Policy (ONDCP) and the White House will do next and how they will leverage their authority to move forward.
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