However, there are important differences between the two medications. They both reduce mortality, overdoses, illicit opioid use, and the spread of infectious diseases like HIV. Methadone and buprenorphine are the two most effective treatments for opioid addiction. There has been a lot of focus on buprenorphine treatment recently. To learn more about the implications of his study, I spoke to Dr. Both groups described internal and external challenges, including concerns about methadone’s side effects and difficulties in maintaining access to the medication. To determine which factors play the largest role in a person’s decision to quit methadone treatment, Thakrar and his colleagues asked patients and staff about why those on methadone decided to stop. To raise retention rates, policymakers must understand the biggest challenges that patients face, but those have been unclear. To improve access to methadone, new strategies are emerging, such as “ low-barrier treatment,” but much remains to be done to increase adherence. Also, federal regulations have not adequately responded to the overdose crisis. This system, developed in the 1970s, persists today in part because methadone is a stronger opioid than buprenorphine. Instead, methadone can be dispensed only from specially licensed “opioid treatment programs.” When patients first start treatment, they must come to these programs five to six days per week to get their daily dose.
Legally, doctors cannot prescribe it to be picked up at a pharmacy. Methadone is part of a unique system of care in the U.S.
To increase treatment, the Substance Abuse and Mental Health Services Administration (SAMHSA) has increased flexibility around dosing, allowing practitioners to provide take-home doses of methadone, the “most effective medication for addiction ever developed,” as LDI Associate Fellow Ashish Thakrar wrote in an opinion piece in the Los Angeles Times.
And of those that do, fewer than half continue taking them long-term, putting patients at higher risk for overdoses and death. Only one in 10 people with opioid addiction get medications for opioid use disorder.
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