Methadone

Because methadone can only be administered in federally-certified opioid treatment programs, the costs and logistics of methadone implementation typically focus on novel settings such as hospitals or prisons/jails: the main cost driver of methadone delivery is the cost of personnel.

Evidence for the intervention

Methadone is an FDA-approved, front-line, evidence-based treatment for opioid use disorder, with over 50 years of research studies supporting its effectiveness. Data supporting methadone comes from multiple rigorous, highly controlled, randomized clinical trials. Trials have generally found that methadone is more effective in higher doses and when delivered over a longer treatment duration. In systematic reviews, methadone has been consistently shown to improve treatment engagement, reduce heroin use, and reduce the risk of opioid overdose death. When compared head-to-head versus buprenorphine, methadone has similar effectiveness and may have slightly better treatment retention.

Evidence-based Scale

Because methadone can only be administered by federally certified opioid treatment programs (OTP), most implementation efforts focus on starting individuals on methadone from other unique settings, such as during a hospitalization or incarceration, or continuing to provide stable doses of methadone from off-site medication units. The costs and logistics of implementing such programs predominantly relate to personnel costs, as starting someone on methadone requires both a clinician to determine appropriateness and dosing and someone to coordinate linkage to an outpatient OTP.