Methadone treatment for opioid use rising, but better access needed to reach more
Treatment numbers rose over the 2010s as the opioid crisis became prominent and also included increases in buprenorphine, an easier-to-access medication.
Methadone treatment for opioid use—which cuts the risk of death by overdose in half—among individuals insured by Medicaid-insured increased substantially after 2010, according to a new Penn Medicine analysis. But researchers say that since as few as a quarter of people with opioid use disorder receive medication treatment, the study highlights a need for expanded access. The research was published in JAMA Health Forum.
“These medications allow people to focus on rebuilding their lives: Finding housing, reconnecting with family, working, and managing other health conditions,” said the study’s co-author, Ashish Thakrar, MD, an assistant professor of General Internal Medicine in Penn’s Perelman School of Medicine. “In other words, these medications are not just symptom relief, but they are cornerstones to recovery. They are saving lives.”
In addition to significantly reducing the chance of death by opioid use disorder, treatment with medications like methadone and the related buprenorphine—which stabilize withdrawal symptoms and opioid cravings—have also been found to increase the likelihood that people will stick with their treatment plans.
In addition to the gains in methadone, buprenorphine prescriptions were also found to increase, though at a higher rate, likely due to ease of access.
Tracking the treatments
Analyzing de-identified national data from 1999 to 2020 on methadone and buprenorphine prescriptions from the Medicaid program, which covers nearly 40 percent of Americans living with opioid use disorder, the researchers found very little use of methadone in 1999. Buprenorphine was not approved for opioid use disorder until 2002.
By 2010, use of methadone and buprenorphine had increased modestly. Methadone use increased from 0.7 to 1.9 prescriptions per 1,000 Medicaid enrollees, and buprenorphine increased to 2.3 prescriptions per 1,000 enrollees through the decade.
A much larger increase in the use of both treatments was seen beginning around 2011, with buprenorphine taking off more than methadone. Methadone prescriptions rose steadily to 6.2 prescriptions per 1,000 enrollees by 2020, roughly tripling its number from 10 years prior. The researchers saw roughly five times more people using buprenorphine for opioid use disorder in 2020 compared to 2010, with the rate standing at 12 people having prescriptions for it per 1,000 Medicaid enrollees.
“Potential explanations for these increases include both the worsening of the opioid epidemic and efforts to increase access to the treatments because of their significant impact on saving lives,” said senior author Sean Hennessy, PharmD, PhD, a professor of Epidemiology.
An issue of access
Buprenorphine outpacing methadone’s increased use was not a surprising finding because it is much more easily accessed by the populations that need it: The medication can be prescribed by doctors in outpatient settings, including primary care.
Methadone, according to federal law, can only be dispensed and taken at certified opioid treatment programs.
“The regulation limits access to methadone, particularly in rural areas or urban spaces that lack adequate public transportation, and for people who might have some inflexible barriers like work or child care responsibilities,” said Thakrar said.
While both buprenorphine and methadone are effective treatments, people who start methadone are more likely to remain in treatment for at least six months, the minimum amount of time required to see benefits from these medications.
“It is also a more attractive treatment option for some patients with opioid addiction who fear the withdrawal that can occur when starting buprenorphine,” Thakrar explained.
In recent years, there have been signs of increased government interest in expanding methadone access for opioid treatment. The Substance Abuse and Mental Health Services Administration (SAMSHA), an agency within the U.S. Department of Health and Human Services, recently allowed for more take-home methadone use. And legislation allowing for methadone to be prescribed by addiction specialists from outpatient clinics, the Modernizing Opioid Treatment Access Act, was introduced in both chambers of Congress in 2023.
The Senate version of the bill is on the legislative calendar, and the House of Representatives version was referred to the House Energy and Commerce Subcommittee on Health.
“This legislation could greatly expand access to methadone for opioid addiction because patients could access treatment from any clinical setting with an addiction specialist, not solely from licensed opioid treatment programs which have limited hours and space.” Thakrar said.