PHILADELPHIA— Methadone treatment for opioid use—which cuts the risk of overdose death in half—has significantly increased among individuals insured by Medicaid since 2010, a new analysis reveals. But with as few as one in four people with opioid use disorder receiving medication treatment, experts say expanded access is crucial.
More People Are Getting Help, But Barriers Remain
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A recent study highlights a rise in methadone and buprenorphine prescriptions, yet access remains a significant hurdle for many.
- Medication-assisted treatment (MAT) with methadone or buprenorphine dramatically reduces the risk of fatal opioid overdose.
- Use of both medications increased substantially after 2010, particularly buprenorphine due to easier access.
- Federal regulations limiting methadone dispensing to certified programs create barriers to treatment, especially in rural areas.
- Legislation to expand methadone access is currently being considered in Congress.
“These medications allow people to focus on rebuilding their lives: finding housing, reconnecting with family, working, and managing other health conditions,” said Ashish Thakrar, MD, an assistant professor of General Internal Medicine. “They are not just symptom relief, but cornerstones to recovery. They are saving lives.”
Treatment with medications like methadone and buprenorphine stabilizes withdrawal symptoms and reduces opioid cravings, also increasing the likelihood that people will adhere to their treatment plans.
Tracking the Trends
Researchers analyzed de-identified national data from 1999 to 2020 on methadone and buprenorphine prescriptions within the Medicaid program, which covers nearly 40 percent of Americans with opioid use disorder. In 1999, methadone use was minimal. Buprenorphine wasn’t approved for opioid use disorder until 2002.
By 2010, use of both medications had modestly increased. Methadone prescriptions rose from 0.7 to 1.9 per 1,000 Medicaid enrollees, while buprenorphine reached 2.3 prescriptions per 1,000 enrollees.
A more substantial increase began around 2011, with buprenorphine outpacing methadone. Methadone prescriptions climbed steadily to 6.2 per 1,000 enrollees by 2020—roughly tripling from a decade earlier. Researchers observed approximately five times more people using buprenorphine for opioid use disorder in 2020 compared to 2010, with a rate of 12 prescriptions per 1,000 Medicaid enrollees.
“Potential explanations for these increases include both the worsening of the opioid epidemic and efforts to increase access to these life-saving treatments,” said Sean Hennessy, PharmD, PhD, a professor of Epidemiology.
The Access Challenge
Buprenorphine’s greater increase in use isn’t surprising, as it’s more readily accessible. The medication can be prescribed by doctors in outpatient settings, including primary care offices.
Federal law restricts methadone dispensing to certified opioid treatment programs. “The regulation limits access to methadone, particularly in rural areas or urban spaces lacking adequate public transportation, and for people facing inflexible work or childcare responsibilities,” Thakrar explained.
While both medications are effective, individuals starting methadone are more likely to remain in treatment for at least six months—the minimum time needed to experience the full benefits. “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 added.
Recent years have seen growing government interest in expanding methadone access. The Substance Abuse and Mental Health Services Administration (SAMHSA) recently allowed for more take-home methadone use. Legislation, the Modernizing Opioid Treatment Access Act, introduced in both the Senate and House of Representatives in 2023, would allow addiction specialists to prescribe methadone from outpatient clinics.
The Senate version is on the legislative calendar, and the House version was referred to the House Energy and Commerce Subcommittee on Health.
“This legislation could greatly expand access to methadone because patients could access treatment from any clinical setting with an addiction specialist, not solely from licensed opioid treatment programs with limited hours and space,” Thakrar said.
This study was funded by the National Institute on Drug Abuse (R01DA048001) and the National Institute of Mental Health (R01MH130435).
