Like most states, Oregon is in need of quality treatment options for opioid-addicted individuals who are ready for recovery.

This article, in the Hillsboro News-Times, features the recent approval by Washington County commissioners to add a new methadone clinic in Hillsboro, Oregon.

Acadia Healthcare is aiming to establish the new methadone clinic in Hillsboro in order to better serve the local community. Acadia already operate a mobile unit in the general area as well as a comprehensive treatment center (CTC) in nearby Tigard located about 20 miles away.

The commissioners voted 5-0 to approve the proposed site which will be on the local bus route thereby providing improved access. The article mentions that Oregon presently has 17 operational methadone clinics serving the state, where fentanyl, opiates, and other substances are causing a grave overdose crisis.

Having local opioid treatment available is a critically important step in saving lives and providing hope to patients and families. Methadone has been proven to decrease opioid use, reduce relapse risks & overdose deaths, as well as increase employment and overall health. Clinics offering medication-assisted treatment (MAT), like methadone and buprenorphine, are forging a new path to safety for those people once stuck in active addiction.

There’s a new spin being proposed on the dispensing of methadone to Opioid Use Disorder (OUD) patients. A federally-funded project is underway between Scene Health and The University of Washington in which patients video themselves taking their daily methadone dose, and then submit that video to the treatment provider.

The project is evaluating this new modified approach that falls somewhere between in-person daily dosing and unsupervised take home dosing.

This new approach is currently being referred to as Video DOT (video direct observation therapy) and has been successfully implemented with other health issues including hepatitis C, asthma, and diabetes.

While this experiment seems appealing at first glance, it does raise legitimate questions about the ability to insure proper safety protocols with the provision of methadone medication to new patients. The project may possibly demonstrate the usefulness of Video DOT methadone dosing. But assuming this new approach one day becomes common practice, it will be important that physicians or clinics have in place a procedure for quickly reclaiming methadone doses that are not ingested on schedule.

Imagine a new patient receives 7 take home doses of methadone, but then only sends in the required video of their medication use on day one. At what point does the prescribing clinic intervene, and how will the unaccounted for doses be retrieved?

Approved Opioid Treatment Programs currently have “callback” procedures in which stable patients are randomly selected to return to their home clinic with their unused take home doses. This allows the clinic medical staff to perform a medication count, and it acts as a safeguard to insure patients are taking their medication as prescribed.

Patients who have earned take home privileges through months of treatment progress are less inclined to divert or misuse methadone than someone who just started treatment. New patients must be inducted gradually on a stabilizing dose of methadone. And time is typically needed to help these patients adjust to methadone while eliminating use of all other illicit substances. This is where the benefit of a structured treatment program is most relevant. OTP’s provide extremely valuable life management skills training in conjunction with medication therapy.

It remains to be seen if “easy access” to methadone is truly an advancement in care, or a step backwards in accountability & safety for patients and the public.

Historically, access to methadone for the treatment of opioid addiction has been through enrollment in a local clinic licensed to dispense methadone. As a result of Covid restrictions, some of these clinic regulations were relaxed. For example, many patients across the U.S. were allowed to begin receiving take home doses of methadone as a result of Covid lockdowns and decreased clinic access.

Critics have begun to express the belief that clinic restrictions are cumbersome and that methadone should be made available for pick-up at local pharmacies. On the other hand, the concern remains that methadone can be misdirected or mishandled thus reinforcing the need for close supervision, particularly in the early phases of opioid treatment. Decades of research has shown that taken under proper supervision, methadone’s safety profile is excellent.

In this recent era of contaminated street opiates and overdose concerns, it is clear that methadone is a phenomenally effective medication for promoting health, well-being, and physical safety.

Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, recently shared that deregulation of methadone would likely increase the diversion of methadone and methadone-related overdose deaths.

Following a period of stability, most U.S. clinics do allow patients to begin dosing at home with methadone. This system of care is working well throughout the country where methadone is readily available. However, many U.S. citizens are still lengthy distances from methadone-approved clinics. So, the challenge continues to link those with opioid addiction to effective resources in their local community. Legislators are presently examining a range of options as the opioid epidemic marches on.