Methadone

Methadone access is limited due to barriers such as geographic limitations, stigma and regulatory hurdles.

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 must be administered by a federally certified opioid treatment program (OTP), access is geographically limited as there are fewer OTPs in some regions compared to others. Access to OTPs is particularly scarce in rural areas. Due to the daily dosing requirements, access to methadone can be especially difficult for individuals who do not have job or childcare flexibility or lack transportation. Off-site medication units, including mobile medication units, have the potential to improve access. Methadone use is also highly stigmatized, which can lead to reluctance among persons with OUD to seek care. Ultimately, the regulatory hurdles associated with becoming a federally certified OTP significantly limit access to care.