Pew report underscores benefits of take‐home methadone

Abstract

Last week a report by Pew Charitable Trusts, based on an interview with Yngvild Olsen, M.D., shows what has been known for years: that take‐home methadone hasn't increased diversion. Olsen, the former director of the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Agreement, also relies on an interview with Matthew Strait, formerly with the Drug Enforcement Administration, and now, as described by Pew, “owner and principal adviser at Controlled Substance Strategies LLC, which partners with pharmaceutical manufacturers and distributors, pharmacies, healthcare organizations, and prescribers to advise on regulatory strategy, policy interpretation, advocacy, and more.” The report, in line with the Pew approach for a few years, promotes not only take‐home medication, but also more liberalizing of opioid treatment programs (OTPs). The report states that reasons OTPs are the only place to obtain methadone for opioid use disorder are “misconceptions and stigma.” Despite the loosening of restrictions on OTPs in 2024, changes overseen by Olsen, not all states followed these changes, “and of those that did, many adopted only some of the changes,” the report states. Asked about diversion, Strait responded in the Pew report: “Because of flexibilities that started during COVID, we now have six years of experience in terms of whether take‐home methadone has increased diversion. And from a 20,000‐foot viewpoint, I would say it has not. And that means actual diversion, not the risk of diversion. Risk is one thing, but actual diversion doesn't bear itself out in the evidence.” Olsen said: “COVID procedures provided that natural experiment we needed to understand the potential impact of broadening access to methadone, since diversion itself is hard to measure. So researchers looked at methadone‐related mortality, which is what we as providers were really worried about.”