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July 15, 2020

Methadone for Opioid Use Disorder—Decades of Effectiveness but Still Miles Away in the US

Author Affiliations
  • 1Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
JAMA Psychiatry. 2020;77(11):1105-1106. doi:10.1001/jamapsychiatry.2020.1511

In 1974, President Nixon signed the Narcotic Addiction Treatment Act, which gave statutory authority to the regulations governing the provision of methadone for the treatment of opioid use disorder (OUD) in the US. The original name for the bill was revealing: the Methadone Diversion Control Act. These regulations that were meant to restrict dispensation on methadone have undergone only modest revision over the ensuing decades even in the midst of a current overdose epidemic.1 In the US, methadone for OUD can only be provisioned at federally certified opioid treatment programs (OTPs). Patients receiving methadone must present to an OTP for initial evaluation and then return 6 days a week for medication dispensing for at least the first 90 days of treatment (the latter requirement was relaxed during the coronavirus disease 2019 [COVID-19] pandemic). At least weekly dispensing is required through the first year and only if patients meet specific requirements. The federal law (42 CRF 8) also mandates patients regularly engage with counseling services; state and municipal governments then layer on additional requirements.

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