A 35 mg liquid dose of methadone at a clinic in Rossville, Ga. Pandemic-era rules that temporarily eased access to the drug – a common treatment for opioid use disorder – have been made permanent in new federal rules announced this month. Kevin D. Liles/Associated Press, file
Pandemic-era rules that temporarily eased access to methadone – a common treatment for opioid use disorder – have been made permanent in new federal rules announced this month.
The new rules will maintain improved access to medication that is prescribed to about 5,000 Maine residents to curb cravings for highly addictive opioids.
When pandemic restrictions went into place in 2020, the federal government relaxed rules that in some cases prohibited patients from taking doses of methadone at home. Prior to the pandemic, many patients had to wait in lines at 10 designated clinics in Maine – sometimes driving hours to get to them – to receive methadone. The patients were required to take the liquid methadone doses from a cup with a nurse present.
But when the pandemic restricted gatherings in 2020 – which made it nearly impossible to offer many in-person health care services – the federal government allowed patients to take methadone doses home more often. Before 2020, patients were required to show up in person at clinics six days per week for the first 90 days of treatment. Some patients would have to wait even longer than 90 days before being allowed to take doses home.
The Biden administration decided this month to make the pandemic rules permanent rather than return to a time when access to methadone was more restricted.
“The relaxation of these regulations has proven to be effective for the long-term recovery of patients,” said Peter Morris, co-founder and CEO of Everest Recovery, which operates substance use treatment clinics in Saco and Manchester that include the use of methadone. “Having take-home medicine allows them to lead a more balanced life with their families and work.”
Morris said another key rule has also been relaxed – doctors can now refer substance use disorder patients immediately for methadone treatment rather than have them wait 12 months before they could start.
A state rule that went into effect in late 2023 is also helping – it permits nurses to pour take-home methadone doses for patients. Prior to late last year, the state required pharmacists to pour the at-home doses, which could cause problems, especially during poor weather when it could be difficult for pharmacists to get to the clinics, Morris said.
Methadone is one of several treatments available for those with opioid use disorder.
Because it’s a stronger drug than buprenorphine – a similar medication under the brand name Suboxone that also curbs cravings for opioids – methadone is generally considered an option for those with more acute cases of substance use disorder. But methadone is also more likely to be abused, which was the rationale for the greater restrictions for patients being treated with it.
Suboxone is more widely used, and patients are not required to show up at a designated clinic. The federal government in recent years has also made it easier to prescribe Suboxone, including allowing it to be prescribed during telehealth appointments.
There are about three to four times as many patients taking Suboxone as methadone, but methadone is still a key part of the strategy for combatting the opioid crisis, said Gordon Smith, director of opioid response for the Mills administration. The administration has expanded the number of methadone clinics from 10 in 2019 to 15 currently.
“This was long overdue,” said Smith, calling the previous requirements “incredibly stigmatizing. We need to continue to lower the barriers for treatment. This is a very positive change by the federal government.”
Smith said another pandemic-era rule that was made permanent increases the initial dosage that can be prescribed. The previous limits, Smith said, did not match some patient’s needs, and if the dose was too weak, the medication would be ineffective at curbing cravings.
Maine saw a decline in overdose deaths in 2023 for the first time since 2018, a 16% year-over-year decrease from 723 in 2022 to 607 in 2023.
Still, the opioid crisis has ravaged Maine and the nation. From 2013-23, 4,648 Maine people died from drug overdoses, with most fatalities connected to opioids.
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