The law restricting access to medication-assisted treatment (MAT) with methadone to opioid treatment programs may have contributed to reducing opioid-related overdose death rates in the United States, according to data presented at the American Public Health Association 2018 Annual Meeting and Expo, held November 10 to 14 in San Diego, California.

“Only about 10% of people with opioid use disorders are able to access medication-assisted treatment, and federal law has been identified as a barrier,” noted study co-investigator, Scott Burris, JD, professor of law at Temple University Beasley School of Law in Philadelphia, Pennsylvania. “We found reason to be concerned that state laws regulating methadone programs may also be a barrier to access, as measured by state overdose rates.”

Despite being considered the “gold standard” for the treatment of opioid use disorder, MAT with methadone is highly regulated in the United States, both at the federal level — with a law mandating that methadone be restricted to opioid treatment programs — and at the state level, with laws in all 50 states and the District of Columbia regulating the use of this treatment.

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The investigators examined legal data from the Prescription Drug Abuse Policy System and deaths related to opioids between 2006 and 2016 gathered from the Centers for Disease Control and Prevention WONDER database and used a mixed effects regression analysis to evaluate the association between a state law on MAT with methadone and opiate-related overdose deaths in that state. State law restrictiveness was assessed by examining 13 features of the law and establishing a binary composite. Using this method, a state law was considered not restrictive when all 13 features were comparable to federal law, which was the case for 20 states and the District of Columbia; the remaining states were considered restrictive with regard to their laws on MAT with methadone. In the latter group of states, such laws were found to have a positive association with the rate of deaths related to opiates.

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“This analysis is the first estimating the effect of law on access to MAT [with methadone]. It sheds light on the need of further research on the effect of other legal levers on MAT [with methadone] and other modes of MAT,” concluded the investigators.

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Gutman A, Coffman D, Grunwald H, Burris S. Exploring the relationship between the restrictiveness of methadone state laws and access to medication-assisted treatment for opioid use disorder. Presented at: American Public Health Association 2018 Annual Meeting and Expo; November 10-14, 2018; San Diego, CA. Abstract 4276.0.