Methadone Works. Congress Has a Few Weeks to Stop Making You Drive 49 Minutes for It.

Picture getting up before dawn every day to take a drug that keeps you alive. In five high-overdose states, the most rural residents face an average 49-minute drive to a methadone clinic, against 17 minutes to a federally qualified health center, according to a JAMA analysis that the Phoenix surgeon Jeffrey Singer cites in Reason. Methadone is an addiction medicine. Distance is the reason many people never get it.

Methadone is a proven treatment we keep behind the hardest door, and the door is a clinic 49 minutes away.

On November 9, Singer, a senior fellow at the Reason Foundation, argued in Reason that the lame-duck session after the midterms is the last easy window to pass the Modernizing Opioid Treatment Access Act 2.0. The bills are S. 4941 in the Senate HELP Committee and H.R. 9790 in the House, and neither has had a hearing or markup on the current version. It would let addiction-certified physicians get a separate DEA registration to prescribe methadone for opioid use disorder and let pharmacies dispense it, taking effect 180 days after enactment. He writes that about 4 million Americans 12 and older had opioid use disorder in the past year and only 15.7 percent, about 623,000, received medication. There are 2,110 federally certified opioid treatment programs, which are the only places that can dispense methadone for this purpose today, and roughly 60,000 retail pharmacies.

The evidence for the drug is not the weak link. A 2020 study of 40,885 people found that those on methadone or buprenorphine had a 76 percent lower overdose risk at three months and 59 percent lower at 12 months. That is an observational comparison, and it covers both drugs, so it cannot say how much belongs to methadone alone. The implementation gates are also real: this is an op-ed about a bill in committee, not law, and pharmacy rules and payer coverage would still vary by state after any federal change.

For providers, the move this week is concrete. Map your patients by drive time to the nearest opioid treatment program and flag everyone more than 10 miles out, because distance is where doses get missed. If the bill moves, you will want that list ready, along with a prescriber on your team who holds addiction certification.

(We covered the earlier Markey pharmacy-access bill in June.) If you are the one making the drive, this is not about a bill number. It is about whether your treatment lives in your town.