December 1, 2022

The under-the-radar battle over opioid addiction treatment legislation
Washington Post, 12/1

In the final legislative sprint of the year, a quiet battle is being waged in Congress over how best to treat certain drug addictions, as the opioid epidemic continues to ravage parts of the country and deaths from overdoses remain historically high.

In many ways, it is a classic Washington showdown: Lawmakers and certain advocates are pushing one policy, while an industry fights to keep it from being enacted.

But the life-or-death nature of the opioid crisis and the destructive path it has cut through all manner of communities have lent an intensity to the debate that you don’t find in the push-and-pull over which corporate tax breaks should be extended.

At issue is access to methadone as a treatment for opioid addiction and whether patients should have to show up at a treatment facility each day to receive their dose or if they can simply call their doctor.

Rep. Donald W. Norcross (D-N.J.) and Sen. Edward J. Markey (D-Mass.) are pushing legislation they introduced one year ago that would enable certified addiction-treatment physicians to prescribe methadone at a local pharmacy for stable patients who could then take the treatments at home. Certain patients would also be allowed to take home as much as a one-month supply of the medication.

Most methadone treatment is required, by federal rulemaking, to take place at a certified opioid treatment facility, known as an OTP. But those rules were eased during the coronavirus pandemic. Norcross, Markey and their supporters argue this flexibility helped patients by making it easier to take the medication. Having to go to a clinic each day is difficult with work, child care, lack of transportation — and there is a stigma associated with going to one, they contend.

Some people also don’t have easy access to an OTP: 24 percent of the population, or 77 million people, don’t have one in their county, according to a 2019 report by the Congressional Research Service.

“The idea of having to go to this one location to pick up your meds is just nuts,” Norcross said.

Ronnie Hartman, 33, can attest. He has been recovering from opioid addiction and using methadone for five years. He’s slowly weaning off the medication but said accessing his treatment makes the road to recovery more difficult.

“I know how hard it can be having to go to the clinic every day in order to get medication,” Hartman said. “It takes a lot of energy and time to get medication that can be used to do positive things during the recovery period to rebuild their lives.”

The pushback
The trade group that represents the clinics, which must be certified and accredited to qualify as OTPs, says that permanently loosening the rules is misguided and that lax oversight of patients by doctors helped created the opioid epidemic in the first place.

The American Association for the Treatment of Opioid Dependence, or AATOD, is the trade group that represents more than 1,800 OTP facilities across the country.

Mark W. Parrino, the association’s president, said he is adamantly opposed to allowing non-OTP doctors to prescribe methadone. He doesn’t trust doctors, he said.

“We have reason. It’s not because we’re paranoid,” Parrino said.

Parrino blames doctors’ over-prescription of opioids, including methadone, in the ’90s and early 2000s to treat pain for the current crisis.

“We think there’s a place for doctors, especially those working with OTPs, but, yes, frankly, to go back to the era of methadone mortality” is not acceptable, he said, referring to the period earlier this century when methadone overdoses spiked.

Markey charges the clinics are just trying to protect their business interests, which he calls a “methadone monopoly.”

“Their lobbyists want to bottleneck access clinics to increase profits,” Markey said in an interview. “Recovery is hard. We don’t need to make it any harder.”

The path to passage
The House version of the legislation was folded into a larger mental health bill that overwhelmingly passed in June with 402 votes, but it has yet to be brought up for a consideration in the Senate. The bill has at least some bipartisan support in the Senate. Sens. Rand Paul (R-Ky.) and Mike Braun (R-Ind.) are co-sponsors.

The legislation’s supporters are looking to attach to it a must-pass bill such as a year-end spending bill or the annual defense policy bill.

Markey said the biggest impediment to doing so is the lobbying campaign being carried out by Parrino’s group.

Rising overdoses
Drug overdoses have increased for the past two decades, with deaths in 2021 surpassing the previous record in 2020 with most of the deaths coming from fentanyl. (Our colleagues Julie Vitkovskaya and Courtney Kan have an excellent explainer on fentanyl.)

Advocates for expanding access to methadone say studies that AATOD is using to undermine the legislation dealt only with methadone treatment for pain, not for addiction recovery, and that the doctors prescribing treatment would have to obtain the highest addiction treatment certification.

Zac Talbott, president of the National Alliance for Medication Assisted Recovery, runs an opioid treatment facility in eastern Tennessee. He said he finds it a burden on some patients deep into their recovery to rely on OTP services.

“Patients who have benefited from OTP that no longer need the services, they should have choice,” Talbott said. “Stabilized patients deserve choices, and this would allow them that.”