Methadone has been used to treat heroin addiction for forty years. In study after study, it’s been shown to be the most effective way to treat opiate addiction. Yet, in these past four decades, methadone treatment has not escaped the clinic system. The biggest reason for this, we can assume, is the fear of diversion. Yet even presumably trustworthy long-term patients must return to the clinic once a month (once a week in some states) and submit to bottle checks and urine tests. Perhaps this is justified; I don’t know. It’s worth noting that patients who receive stronger painkillers than methadone in a doctor’s office for pain and disease are subject to no such scrutiny. Junkies are junkies, I suppose, and the prevailing wisdom is that they can never be trusted.
But contrast the clinic model with the way buprenorphine (Suboxone) treatment is handled in America. Patients may still be subject to urine tests and medication counts, but they have the dignity of being treated in a doctor’s office. This way, patients are treated for and receive their medication like they have a disease. When patients are subject to the clinic regime, with the inherent accusation that they cannot be trusted, addiction is reduced to a moral failing.
So why isn’t methadone dispensed in an office setting, like Suboxone is? Well, it is, but here’s the catch: you have to be a long term, stable patient, and you have to live in one of the two cities in the entire country that I know of that treat patients with methadone this way. It’s called office-based opiate treatment, or OBOT for short. There is a separate exception in federal law for this type of treatment. As I mentioned, I only know of two cities in the U.S. where this is happening: Baltimore and New York City.
Why is this so rare? Well, it may be for several reasons. First of all, it’s not necessarily easy to obtain permission from the government to do this. Physicians need to obtain an exception to the usual rules governing methadone treatment. Doctors have to find themselves a methadone clinic to work with and supply the meds. They are subject to many regulations. My main guess at why this isn’t more popular is that there’s no money in it. There is not a large patient population for doctors to service with this treatment, because only patients who have been stable and on methadone and drug free for two years are allowed on the program. Now, think about buprenorphine treatment. A doctor can have up to 100 Suboxone patients under their care now. Perhaps the biggest incentive is that many insurance companies cover Suboxone (though certainly not all), while most companies don’t cover methadone maintenance.
How simple it would be for methadone patients to escape the clinic system by visiting a doctor for their medication once a month. What’s most depressing about this is that it’s actually something that could be a reality, but because of red tape and profit motive, it’s virtually nonexistent.
To learn more about OBOT, check out the links on this page: