“For too long, we have kept methadone—an evidence-based, life-saving medication—locked away, far from many of the people who need it,” Markey said. “The Modernizing Opioid Treatment Access Act 2.0 of 2026 would take a carefully considered step forward in expanding access to this medication by allowing the most highly trained addiction physicians in the country to prescribe methadone for their patients to pick up at a pharmacy. We must knock down barriers to treatment for people at risk of opioid overdoses—not build them up.”

He’s right that knocking down barriers to methadone is long overdue. But would MOTAA 2.0 unlock access for everyone who needs it? The answer is no. Nothing in the updated bill addresses the fundamental problems in the 2023 version.

“We know that there aren’t enough addiction medicine physicians and psychiatrists in the country.”

As Filter reported at the time, the first iteration of the bill contained fatal flaws. Limiting non-clinic prescribing to physicians board-certified in addiction medicine would exacerbate racial disparities in access to medications for opioid use disorder (OUD). It’s also just not nearly enough. There are about 6,400 doctors with this certification. About 600,000 patients currently take methadone.

“We know that there aren’t enough addiction medicine physicians and psychiatrists in the country to expand care to everyone who needs it,” a representative from the office of Sen. Markey told Filter.

“The goal of the bill is to expand the universe of providers who can prescribe methadone,” they continued. “It starts this expansion by allowing health care providers with the greatest expertise in addiction treatment—board-certified addiction medicine physicians and addiction psychiatrists—to prescribe methadone outside of an OTP.”

When it comes to prescribing methadone for OUD specifically, however, doctors board-certified in addiction medicine have no more experience than other doctors—because none of them have been able to do it. The law has restricted this to physicians who work in opioid treatment programs (OTP). There are approximately 2,100 OTP in the US, the majority concentrated in urban centers.

“One of the main changes in MOTAA 2.0 compared to the version introduced last Congress is the addition of language to allow the HHS Secretary to designate providers able to prescribe methadone outside of an OTP setting, in addition to board-certified addiction medicine physicians and addiction psychiatrists,” Sen. Markey’s representative said. “These providers would need to be licensed and registered to prescribe controlled substances.”

But who are these other providers? The representative didn’t say. The bill itself states that they would be “otherwise determined by the Secretary, under standards established by the Secretary.” The language is troublingly vague.

We still don’t know who the “future licensed providers” would be, nor any timeline. And what’s to stop HHS using its new “flexibility” to do precisely nothing?

The American Society of Addiction Medicine (ASAM) interprets the sentence to mean, “The HHS Secretary could add other qualified prescribers, who would remain subject to applicable state scope-of-practice laws…” But who are the “other qualified prescribers”?

Kelly M. Corredor, chief advocacy officer at ASAM, confirmed via email to Filter that the organization was involved in drafting the updated bill. But when asked who the other qualified prescribers would be, she wouldn’t specify.

According to a press release from Rep. Donald Norcross (D-NJ), a sponsor of the bill in the House this provision means, “flexibility for the Department of Health and Human Services to authorize future licensed providers without Congress needing to pass a separate law.”

But we still don’t know who the “future licensed providers” would be, nor any timeline on which this might happen. And what’s to stop HHS using its new “flexibility” to do precisely nothing?

MOTAA 2.0’s inclusion of more providers, however ambiguously, is a direct response to methadone reform activists’ criticisms of the original MOTAA. But its terms offer no guarantee that the HHS secretary will ever allow more prescribers.

Unfortunately, other provisions that helped doom the original MOTAA made it into 2.0. Participating doctors would need a special registration from the Drug Enforcement Administration (DEA)—extra surveillance that will deter some as has been the case with buprenorphine. The other poison pill is that any state attorney general could stop registering new providers and revoke or deny a registration.

“We cannot allow ourselves to become embroiled in territorial turf wars over prescribing privileges under the guise of ‘modernizing.’”

ASAM is the leading advocate for MOTAA 2.0. This conservative medical society has done almost nothing to end three decades of a crisis that has seen over 1 million people die from an opioid-involved overdose. It’s notable that ASAM had zero interest in reform prior to the pandemic. Given this abysmal track record, on what basis should its members have the exclusive right to prescribe methadone outside of clinics?

“The urgency of providing access to life-saving medications for people dealing with substance use disorders, particularly opioids, cannot be overstated,” Jerry Otero, who takes methadone and is the manager of the Drug User Health Hub at St. Ann’s Corner of Harm Reduction, told Filter. “We cannot allow ourselves to become embroiled in territorial turf wars over prescribing privileges under the guise of ‘modernizing.’”

In 2023, Dr. Stephen M. Taylor, then president-elect of ASAM, (now president), testified to a US Senate committee: “MOTAA is not methadone for everyone, prescribed by anyone. It represents a responsible expansion in methadone access for OUD.”  Taylor’s statement shamefully carried no sense of urgency to save lives. The incremental, “responsible” expansion he advocated would free very few patients from the carceral clinic system.

ASAM’s description of MOTAA 2.0 as having strong federal and state oversight and safety guardrails” plays into the worst discrimination against methadone patients—the notion that they can’t be trusted and must be continuously monitored.

ASAM’s one-pager on the new bill has a section titled, “Improve Patient Safety and Address Diversion.” Diversion isn’t a major problem; lack of access is. This DEA framing panders to the idea that methadone is a uniquely dangerous medication. It’s not.

The first bullet point states that ASAM supports the terrible idea of DEA special registration of doctors. This is the DEA that has kept methadone under lock and key as people die; the DEA that has made the unregulated opioid supply exponentially more dangerous by pursuing its deadly drug war. Yet instead of campaigning to get these killer drug warriors out of addiction medicine, ASAM cosies up to them and rarely, if ever, criticizes their actions.

The second bullet point endorses the use of prescription drug monitoring programs (PDMP) for methadone dispensed through community pharmacies. According to those who’ve studied them, PDMP are tools of law enforcement and often harm patients.

“There is one thing that prescription drug monitoring programs are really good at, and that is bringing down prescribing rates,” said Dr. Elizabeth Chiarello, author of, Policing Patients: Treatment and Surveillance on the Frontlines of the Opioid Crisis. “But overdose is through the roof.”

Other ASAM bullet points welcome MOTAA 2.0’s ideas of states setting dispensing limits, which many will do to the detriment of patients, and prescriptions being written for “supervised use”—meaning pharmacists would be required to watch certain patients swallow methadone, just as clinic nurses do.  

“This bill, in action, will keep methadone out of reach for the patients who need it the most.”

The Modernizing Opioid Treatment Access Act 2.0 doesn’t modernize access to methadone. It’s designed to fail by handing a small group of doctors a monopoly on prescribing to a small group of patients, who will skew wealthier and white. And it gives states veto power over new providers—states like West Virginia, which is so hostile to methadone that it’s had a moratorium on opening new clinics for 19 years.

In line with the DEA narrative, MOTAA 2.0 emphasizes diversion control and surveillance of patients; it reinforces stigma.

“This bill, in action, will keep methadone out of reach for the patients who need it the most,” Otero said, “by overcomplicating who can prescribe.”

A bill to truly modernize access to methadone would abolish the clinic system and permit all provider prescribing.

The obfuscating language in MOTAA 2.0 that might, maybe mean more providers can prescribe sometime in the distant future—who knows!—is an insulting trick to make methadone reform advocates believe 2.0 is a different bill from its predecessor. It’s not.

Instead, believe Dr. Taylor when he says, “MOTAA is not methadone for everyone, prescribed by anyone.” 

Image by Helen Redmond

The post MOTAA 2.0 Is Not Real Methadone Reform appeared first on Filter.

It was a historic victory to those who support access to a variety of safer nicotine products—including flavors, which research and experience have repeatedly shown to be key to many people’s ability to switch from cigarettes. Access is vital because combustible tobacco use is still the leading cause of preventable disease and death in the United States. Smoking kills more than 480,000 people each year.

“The amount the company had to spend was in the high double-digit millions of dollars … We had numerous meetings with the FDA, navigating the process through substantial scientific review.”

Sean Greenbaum, the founder and president of Glas, explained to Filter how the company got through the FDA’s expensive and legendarily arcane Premarket Tobacco Product Application (PMTA) process.

“We started working on our application in 2019,” he said. “The amount the company had to spend was in the high double-digit millions of dollars. It was a significant investment of time, resources and capital. We had numerous meetings with the FDA, navigating the process through substantial scientific review, various deficiency letters, and we responded to all the questions they had. We conducted scientific, clinical and age restriction studies.”

Not everyone celebrated that blueberry and mango vapes passed FDA muster. The Campaign for Tobacco-Free Kids (CTFK) and Parents Against Vaping Electronic Cigarettes (PAVE) were apoplectic.

CTFK trotted out the old, tired and false narrative that “kid-friendly” flavors’ purpose is to hook youth. “By authorizing fruit flavors and allowing e-cigarette makers to disguise them with names like Gold and Sapphire, the FDA is risking a resurgence of youth e-cigarette use,” President Yolanda C. Richardson said in a press release. “History can’t be allowed to repeat itself; mango was one of the most popular Juul flavors that contributed to a past surge in youth e-cigarette use before it was pulled off the market.”

Their fury flows from a sense of betrayal towards an agency that has generally caved to their demands.

On a PAVE webinar to discuss the FDA decision, cofounder Meredith Berkman was enraged: “It’s a catalytic moment where the FDA has failed us. Has failed American families. Has failed to live up to its regulatory authority to protect public health and the health of our children … It’s shameful that at this moment the FDA has been co-opted by the predatory tobacco industry.” Apparently the mango-hating Manhattanite doesn’t know that Glas is an independent vape business that’s never been affiliated with the tobacco industry.

The apocalyptic language over the sale of two fruit-flavored vapes is ridiculous. Surely CTFK and PAVE are aware that vapes in dozens of fruit flavors are easily purchased on the booming illicit market created by the FDA’s obstructionism? Despite this, there has been no increase in youth vaping for years—in fact, the number has dropped sharply.

Their evidence-free claims that the legal availability of flavored vapes will unleash another teen vaping “epidemic” are an attempt to create another drug panic and to bully the FDA into reversing its decision. Their fury flows from a sense of betrayal towards an agency that has generally caved to their demands.

FDA Commissioner and tobacco control lapdog Marty Makary was toeing that line in April when he issued a memo preventing the authorization of Glas menthol, mango and blueberry vapes, after FDA scientific reviewers green-lit them. Then the Trump Whitehouse got involved and suddenly they were authorized. Weeks later Makary resigned specifically over this issue. Don’t be surprised if he ends up working for CTFK. That’s where Brian King, the former Director of the FDA’s Center for Tobacco Products, is now employed.

PAVE initiated a letter-writing campaign demanding repeal of the authorization. Joining the attack are 21 state attorneys general who wrote a letter to the FDA urging it to “reverse guidance easing sales of flavored e-cigarettes.”

“DARS are an information-gathering device masquerading as a youth prevention.”

Tobacco control organizations and other groups have another bone to pick with Glas. They have denounced the “device access restrictions” (DARS) technology, arguing it won’t stop tech-savvy youth and deploys Big Brother spying software.

“DARS are an information-gathering device masquerading as a youth prevention,” stated Willow Najjar Anderson, an attorney at the Public Health Law Center. “They give the industry a socially responsible gloss while doing little to stop youth from seeing, wanting or accessing flavored vapes. Moreover, privacy concerns with DARS remain real, especially when access to an addictive product is conditioned on surveillance, biometric check-ins, and data collection.”

Anderson makes an important point about the monitoring features embedded in the Glas app. Where do the information and photos collected by the company go, and who has access to them? In an era of powerful hacking groups, rampant identity theft and massive data breaches, this might be a deal-breaker.

I asked Greenbaum why Glas did this. “We wanted to take a very conservative approach that presented zero risk in regards to any form of appealing to youth, and we combined that with our extensive and robust age-restrictive technology,” he said. “We conducted two age restriction studies. The first study didn’t expose youth to the brand or the physical product. We put the technology in their hands and provided them the opportunity to game the system. They couldn’t. Then the FDA told us to put the actual vape in the hands of young people, and we conducted the same set of tests where they tried to game or break the system. Zero youth were able to.”

That’s a lot of steps to puff on a vape. Compare that to how fast and easy it is for anyone—of any age—to pick up and smoke a cigarette.

Here are the steps to activate a Glas flavored vape. Before it can be unlocked, the device has to be paired with a smartphone app, so the first step is to download the app. The next step is uploading a government-issued ID and a real-time selfie, which the software analyzes to confirm legal age. Once verified, a digital certificate is sent to the vape, allowing the heating coil to be activated. Sensors in the vape actively monitor the connection to the smartphone, and if the phone is moved out of close range of the vape, or if it is turned off, the vape automatically deactivates.

That’s a lot of steps to puff on a vape. Compare that to how fast and easy it is for anyone—of any age—to pick up and smoke a cigarette. Or use an unauthorized, non-age-gated vape, for that matter.

“Every new technology product has a little bit of a hurdle in the beginning, but our process is seamless and efficient,” Greenbaum said. “From the perspective of thinking about all of the products that we use as consumers in today’s world, everything for the most part is connected and you have some form of a mobile app. The process that we have for verifying a user, it occurs in under three minutes. It’s similar to a mobile banking app. In our studies we pulled from a demographic of heavy smokers of all ages and demographics, and the ease of use on the technology side was not a concern for them.”  

To be sure, some people will be able to activate the device, but seriously, in under three minutes and nothing will ever go wrong?

It’s a feature that is the opposite of user-friendly—but this is where the FDA, and the manufactured outcry at “kid-friendly” flavors, have gotten us.

What Greenbaum isn’t taking into account is the digital divide that is a reality for low-income, vulnerable populations, especially in rural areas, that have the highest rates of smoking. People who are street-homeless often don’t have consistent access to wifi, often don’t have government-issued ID, and cell phones get lost, stolen or are shut off for nonpayment. People with serious mental health diagnoses might have cognitive or functional impairments that limit their ability to follow directions to activate the vape.

Another problem is that the pleasure of inhaling nicotine could be lost because the freedom to move around while vaping is compromised by the technology. I envision people forgetting that they have to keep their cell phone and vape in close proximity and the device abruptly deactivating. Annoying! It’s a feature that is the opposite of user-friendly—but this is where the FDA and the manufactured outcry at “kid-friendly” flavors have gotten us.

It was a seven-year battle to get FDA authorization of flavored vapes. But if age-gating surveillance technology becomes the norm and makes vapes too difficult, frustrating, time-consuming or invasive to use, then tobacco control zealots will have found yet another way to block the use of safer nicotine products. 

Photographs courtesy of Glas

Correction, July 24: A previous version of this article incorrectly stated that the FDA did not issue a press release about the Glas authorizations. In fact, the agency did issue a press release on May 5.

The Influence Foundation, which operates Filter, has received unrestricted grants from Juul Labs, Inc. Filter‘s Editorial Independence Policy applies.

The post The Glas Ceiling: Gold, Sapphire and Vaping Surveillance appeared first on Filter.

“We have to take care of people in a different manner,” Lurie said, “and it’s not by allowing them to continue to use and die on our streets.” A “different manner” actually means a crackdown. It means street distribution of foil, pipes and plastic straws is no longer allowed, with programs that offered harm reduction supplies from tables on sidewalks ordered to move indoors. It means more destruction of tent encampments, more police harassment and ticketing of people sitting or laying on sidewalks. 

The controversial Reset Center, described as a “law enforcement-led crisis stabilization center,” was opened in May. Police bring people they deem to be under the influence of drugs to be held in the locked facility for 24 hours.

This is the climate in which the Harm Reduction Therapy Center (HRTC) now operates. Founded in 2000, HRTC offers free counseling, operates a drop-in center and distributes safer-use kits to people who use drugs.

“We are not moving that person in a direction that somebody else thinks is important.”

They also have a van that parks in several neighborhoods and operates as a mobile pop-up, drop-in center. Their harm reduction therapy comes with hospitality: comfortable seating, canopies, coffee, snacks or a hot meal. It’s truly “meeting people where they’re at.”

HRTC’s Maurice Byrd and Anna Berg are all too familiar with the current backlash against harm reduction in San Francisco. Byrd is a licensed marriage and family therapist, and the center’s clinical training director. Berg is a licensed clinical social worker, and the clinical program director. Both have decades of experience working with people around drug use and mental health diagnoses.

Filter asked Byrd and Berg for their thoughts about the changes under Mayor Lurie, the human impacts of the rejection of evidence-based harm reduction services, and how this reflects an era of rising authoritarianism. Our interview has been edited for length and clarity.  

Helen Redmond: What is your response to the critics of harm reduction who say it enables people to use drugs and keep on using?

Maurice Byrd: Harm reduction enables people to stay alive. It enables a person to be healthy and as safe as possible. Ultimately, we’re not invested in people continuing their drug use if that’s what they choose and we’re not invested in people pursuing abstinence unless that’s what they choose. And I think that is what is difficult for people to really understand and that’s what is controversial. As harm reductionists, we don’t come in with a goal in mind for someone. So we’re truly in a collaboration with our clients to create those goals.

Anna Berg: When you say you’re enabling, it brings up an assumption that there’s something that somebody wants the person to do—that we are not forcing them to do. And so we are not moving that person in a direction that somebody else thinks is important. 

MB: I have a quick story. We were working at a shelter-in-place site, and a staff person who is now under scrutiny from the law called me into the office and asked, “Are you going to give our clients drugs?” That was her question! 

I said, “Wouldn’t that be illegal for me to give your clients drugs?” And I said no, I would not. Then she asked, “Well, you’re going to make sure they have drugs?” And I was like, “I’m not in the business of drug dealing. I’m a therapist.”

AB: We also want to help people think about what their options are. And sometimes folks get into spaces where it’s hard to know what the options are, they forget, get in a pattern, or in a survival place where all somebody can think about is what’s the next few moments. It’s part of our job as harm reduction therapists to help people explore and consider their options. And that’s the thing we enable people to do.

HRTC staff with the center’s van

HR: In a recent article by German Lopez in the New York Times, he wrote, “People struggling with addiction often need an outside push—from a family member, a friend or ultimately the government—to seek help.” Lopez argued the majority of people he’s interviewed said they needed threats and pressure to stop using drugs. What is your response? 

MB: We’ll just call that for what it is: cherry-picking. That’s a cherry-picking story. Do you know the number one way that people recover? It’s on their own without any intervention, something we call “aging out.” It’s not harm reduction, it’s not AA. It’s actually just spontaneous. 

I spent a fair amount of time in forensics working with people in custody in the San Francisco County Jail and San Quentin State Prison. I don’t want to completely say that coercive treatment, even though I disagree with it greatly, hasn’t been a starting point for some people. There could be an intervention that helps people jump off and do something different. It could be a starting point for some, but overall, that’s absolutely not how people recover.

AB: Change is hard, even if it’s something you really, really want to do, even if it’s something people in your life really want you to do. You have to have a sense of possibility, hope, and empowerment to take on change. Coercion and carceral treatment takes all the empowerment out and just forces and traumatizes folks. It undermines the whole change process. It causes harm and then what a lot of folks are doing to cope with harm is maybe the thing that brought them in contact with law enforcement in the first place. There’s something very misguided about what people think substance use treatment should look like. It can be authoritarian and paternalistic. 

HR: Critics of harm reduction are saying the focus is too much on drug-user rights and not enough on the impacts of drug use on families and communities. 

MB: We hear this mostly from politicians. This is a political question, because politicians could do something about it. You can make more drop-in centers. You could, God forbid, make safe consumption sites so people are not using outside on the streets. Oh my God, why not house people so that they have their own safe consumption sites, which is for most people their home?

Other countries have decided that they don’t want any neighborhood to be open drug zones, like Switzerland. So they invest in those neighborhoods in ways that reduce it. They decriminalize or legalize substances.

The politicians want to lay it at our feet because we treat people who use drugs with dignity and respect in a way that other people do not. We do it in a public way. I think that’s hard whenever people see that we’re treating people with respect, and they’re like, This person doesn’t deserve respect.

This is not a problem of harm reduction and this is not a treatment question. There is a scapegoat that needs to be created.

AB: You could actually make quality, engaging, compassionate treatment that people would be excited to go to because the whole person is attended to, not just one aspect of their life. 

Harm reductionists are looking at harm and impact and we’re looking at it on multiple levels. If there is harm to communities, families or to individuals, that needs to be part of the conversation. And that absolutely is part of the conversation in San Francisco. We’re in the business of trying to be part of the solution and invite folks into a thoughtful conversation of what their needs are. 

“They’re looking for people who fit a particular demographic. The other troubling part about the Reset Center: You’re not being arrested or detained—in my opinion, that’s being kidnapped.”

HR: Talk about the newly opened Reset Center in San Francisco. 

MB: It’s authoritarian. Who do you pick up off the streets? Unconscious bias exists, racism, and most of them are going to look like Black and Brown people. They are the ones who are going to get snatched off the street. Most of them are going to look like “people who use drugs”and people who are experiencing homelessness.

If they’re looking to take people off the streets who are inebriated, go to the Marina District. Go to the Marina every night. Go to the Castro every night. Go to these neighborhoods. [Instead] they’re looking for people who fit a particular demographic. There is the other troubling part about the Reset Center: You’re not being arrested or detained—in my opinion, that’s being kidnapped—and you can’t leave until you are cleared by someone. 

AB: We don’t want people to be outside using substances and struggling. Let’s invite people inside. Let’s do that. It will cost less. It will get less pushback. If we do that, we won’t have court cases—because we’re bordering on some legality issues with the Reset Center.

HR: What does the drug treatment landscape look like in San Francisco? 

MB: Since the ‘80s, we don’t have community mental health centers in the sense that we used to have them. Why don’t we take some of the money out of waging the drug war and invest that in actual treatment? 

This idea of a “War on Drugs” is obnoxious because you can’t get into a war with drugs, it has to be people. We’re in the middle of prohibition right now that’s killing people because we’ve decided to let drug dealers figure out the quality of the fentanyl that is being used, not the government. So this is a prohibition issue, it’s a race and class issue, too. 

There’s a big push with the Reset Center, they want people to go into treatment. Where are they going to go? There isn’t enough treatment available.  

We need treatment on demand, low-threshold—the lowest threshold possible. Wouldn’t that be phenomenal, if somebody walked up to a place and said, “I’m ready for residential treatment” and they walked right through the door?

AB: How do we do it that any door is the right door for somebody to come into treatment? As a service provider, I’ve experienced the barriers to treatment. There’s a phone number to call to get somebody into residential treatment or for intensive case management services. Every time I call, I’m asked, does that person have all their medications with them, any suicidal thoughts in the last 90 days, do they have insurance, an ID? Even when I have that person, there’s a wait.

“We need housing that is nice, not shitty, that doesn’t take all your money and you have rats for roommates.”

HR: Mayor Lurie and the San Francisco Board of Supervisors have rejected harm reduction and said it’s been tried and it’s failed. Where is that coming from?

AB: We’ve never fully implemented the principles of harm reduction into our drug treatment system, in our care system or in our health care system. We can’t say that it hasn’t worked, because we actually have not fully implemented or adequately funded programs. And it’s the same for Housing First. People say that they have a Housing First model and folks adopted some of the spirit of it, but a true Housing First model is really beefed up on services, has a really high touch point, and offers an array of supported services.

We need housing that is nice, not shitty, that doesn’t take all your money and you have rats for roommates.

The facts don’t matter. Politics and emotion dictate public health policy now. We’re in an era of rising authoritarianism, and only folks with money matter. We’re in this space where certain people’s opinions are more important than others. It’s leading us into a big mess.

MB: We never fully realized the dream of harm reduction. Since 2000 every contract for social services [in San Francisco] had to have a harm reduction philosophy. I call it a philosophy, because it’s not actual policy. It’s what we call “diet harm reduction,” or harm reduction-light—which means that it was written in your contract, more than anything else.

The problem with authoritarianism is that you don’t listen to people. You don’t listen to people like Anna or myself or Jeannie Little or Patt Denning, who have been doing harm reduction based work in San Francisco with people experiencing homelessness and using substances and mental health issues for 30 years. 

We’re really right on the verge in San Francisco of violating human rights. We’re like, right there. We’re taking freedom away from people.

Photographs by Helen Redmond

The post “It’s Authoritarian”—Harm Reduction Under San Francisco’s Backlash appeared first on Filter.

The April 24 letter, written by SAMHSA Principal Deputy Assistant Secretary Christopher Carroll, explains the new approach. “SAMHSA remains committed to expanding access to comprehensive, evidence-based treatment,” it states, “including the use of medications … But we are equally committed to ensuring that medications are part of the pathway to long-term recovery and sobriety, self-sufficiency, and thriving, not as a default sentence to life-long medication use.” 

So getting people off of life-saving medication is “equally” important as making sure people at risk of overdose have access?

Underneath Carroll’s carefully coded language is an anti-medication bias, and the false notion that to truly be in recovery, medication must be discontinued.

Terms used throughout the letter—“shorter course of treatment,” “consider tapering and medication discontinuation,” “SAMHSA funding can also be used to support individualized tapering and discontinuation of medications when clinically indicated,” “at least annual reviews for continuing treatment,” “consideration of medication treatment duration”—illustrate prejudice against the long-term use of MOUD.

The idea that real recovery requires “living a drug free life,” as the letter puts it, is still pervasive.

Pressuring people to stop methadone isn’t new. Since the creation of the clinic system in the 1970s, there’s been a never-ending battle between viewing it as a maintenance medication, or the opposite—a short-term drug to get off of as rapidly as possible for fear of “enabling addiction.” Some patients report having to taper off in weeks or even in a few days, which is dangerous. It’s known as a “suicide detox.”

There is a long history of clinic counselors, particularly those who formerly worked in therapeutic communities where abstinence is demanded, badgering patients to get off MOUD because it’s “substituting one drug for another.”

That stance has changed in some opioid treatment programs (OTP) amid the life-or-death reality of the opioid-involved overdose crisis.

“My experience is that they are more inclined to push patients up, not to get off or taper down,” Jerry Otero, a person who takes methadone and the manager of the Drug User Health Hub at St Ann’s Corner of Harm Reduction, told Filter. “But it’s kind of arbitrary and it depends on the counselor.”

Yet in the public eye, the idea that real recovery requires “living a drug free life,” as the Dear Colleague letter puts it, is still pervasive.

Many report enormous pressure to stay on methadone. On the other hand, many are forced off it against their will.

The truth is, the clinic system is a Wild Wild West, where the pressure can go both ways and patients have little control over their dosage.

Many report enormous pressure to stay on methadone, even when they want to taper off, which has much to do with maintaining OTP revenues.

Bill Kinkle, a registered nurse who took methadone for many years, faced stiff opposition from clinic staff when he decided to taper off. “There was major pressure to stay on indefinitely,” he told Filter. “In fact, one doctor went behind my back and brought my partner and kids in for an ambush meeting to try and guilt me into remaining on methadone despite me giving concrete, objective evidence of why I desired to be off medication.”

On the other hand, many people who want methadone are forced off it against their will or have their dose decreased as punishment. Staff can lower the amount of methadone for missed doses, or refuse to give a dose if a patient can’t produce a urine specimen. Then there is administrative withdrawal, known as a “feetox,” when patients are forced to taper off due to nonpayment of clinic fees.

People stop taking methadone for a raft of reasons, but often it’s related to the clinics’ culture of cruelty that demands daily dosing and humiliates and punishes them—not to the medication itself.

People deserve to make their own choices armed with evidence-based recommendations. Coercing patients to quit MOUD is not evidence-based.

In the fentanyl era, discontinuing medication that is proven to cut the death rate from overdose by 50 percent is a serious risk. So it makes sense for OTP staff to be concerned if a vulnerable patient wants to stop taking methadone. Ultimately though, it should be the patient’s decision—whatever that is should be supported. And patients who change their minds and return should be welcomed right back into treatment.

People deserve to make their own choices armed with evidence-based recommendations. Coercing patients to quit MOUD is not evidence-based. The American Society of Addiction Medicine concluded two decades ago that methadone should be considered a long-term treatment.

Abysmal rates of retention in opioid treatment programs are evidence that many patients aren’t staying on medication long enough. And according to the Centers for Disease Control and Prevention, 75 percent of people who could benefit from MOUD don’t get prescribed them! So what’s SAMHSA’s hurry to get people off medication, when the real problem is they can’t get on it?

Methadone and buprenorphine have been proven to be safe and effective when used long-term. People take many other prescribed drugs for years; cholesterol- and blood pressure-lowering medications, GLP-1 drugs to maintain weight loss, insulin to manage blood sugar levels, or anticoagulants to decrease the risk of blood clots and strokes. There is no federal guidance to taper off these medications so that treatment doesn’t become “a default sentence to lifelong medication use.”

 The ill-advised “Dear Colleague” letter exposes a fundamental problem: SAMHSA’s involvement in the dispensing of medication for opioid use disorder is an unjustified intrusion into the patient-provider relationship. It’s yet one more reason why methadone must be deregulated and integrated into health care and community-based settings. In other words, treated like every other medication in the pharmacopeia. 

Photograph by Helen Redmond and Marilena Marchetti

The post “Consider Tapering”—SAMHSA Turns Against Long-Term Methadone Use appeared first on Filter.

A single psilocybin dose combined with cognitive behavioral therapy (CBT) was more effective for quitting than the nicotine patch paired with CBT, found a recent study by researchers at Johns Hopkins University School of Medicine and the University of Alabama at Birmingham.

Psilocybin acts on serotonin receptors and can alter perception, mood and thought. What exactly is behind its demonstrated potential for smoking cessation? 

“We don’t know for sure, and it is not likely one mechanism,” Dr. Matthew Johnson, one of the study authors, told Filter. “It most likely is an increase in mental flexibility and learning, combined with a perspective-shifting subjective experience.” 

At six-month follow-up, 40.5 percent in the psilocybin cohort were abstinent compared with just 10 percent in the nicotine patch cohort.

The 82 study participants, aged 21 to 80, were people who smoked daily and had more than one previous unsuccessful quit attempt. All received 13 weeks of CBT that included keeping a daily smoking diary, listing reasons for quitting versus continuing to smoke, exploring health and financial drawbacks of smoking, and developing strategies to manage cravings and withdrawal. 

The trial randomized participants to additionally receive either one 30 mg dose of psilocybin or a nicotine patch. The participants in the psilocybin group received education regarding the effects of the drug, and the protocol for its administration involved laying on a couch wearing eyeshades while listening to music through headphones. 

On the day after the target quit date, 38 psilocybin participants (90.5 percent) and 32 nicotine patch participants (80 percent) self-reported achieving 24 hours of abstinence from smoking. At six-month follow-up, 17 participants (40.5 percent) in the psilocybin cohort were abstinent compared with just four participants (10 percent) in the nicotine patch cohort. No serious adverse events were reported in either group.  

The researchers wrote, “The results of this study add to the increasing evidence that psychedelic treatment may have general anti-addiction efficacy across various addictive drugs,” the researchers wrote, “[… and] suggest that psilocybin holds potential in the treatment of tobacco use disorder and, along with other psychedelics, should be investigated further for tobacco and other substance use disorders.”

It is vital that future research allows diverse cohorts to benefit from trials.

There were significant limitations to the study, including a glaring lack of racial diversity among participants: Just 3.7 percent were Black and none were Indigenous, while 89 percent were white. Study participants had to be “psychiatrically healthy,” so people with schizophrenia, depression or bipolar disorder were excluded. People with a recent substance use disorder or a positive drug screen were also ineligible.  

Black and Indigenous people, people with mental health diagnoses and people who use (other) drugs are all among those most vulnerable to smoking-related harms! It is vital—especially when the study concludes that various psychedelics should be further investigated for substance use disorder—that future research is designed to represent these populations and allow diverse cohorts to benefit from trials. Failure to do so would be research malpractice.

And why use nicotine patches in the study, when decades of research has demonstrated low rates of efficacy? “There are more studies for the patch, it is FDA-approved for smoking cessation, and there is no variability across products,” Johnson said.  

Perhaps a better comparator would have been vapes; a growing number are FDA-authorized, and vapes in general have proved more effective than Nicotine Replacement Therapy.

Photograph by afgooey74 via Flickr/Creative Commons 2.0

The post Psilocybin Shows Growing Potential for Smoking Cessation appeared first on Filter.

A young woman is strapped down in a black reclining chair, her mouth covered by an oxygen mask with a vape attached to it. It forces her to inhale vapor continuously. X-rays of the brain and lungs hang on the wall. Meanwhile rats investigate vapes, and nicotine pouches are strewn all around them. It’s macabre.

“When you use nicotine pouches or vapes, your body is part of Big Nicotine’s experiment …” the text reads. “You’re not just their customer, you’re their lab rat.”

It’s all part of yet another fear-based campaign designed to demonize the use of safer nicotine products:  “UNDO: End Tobacco Damage Now,” is currently being promoted by the California Department of Public Health.

It is hard to imagine any other public health campaign around drug use referring to people as rats.

It brazenly insults people who use safer nicotine products. “Are you one of Big Nicotine’s lab rats?” the campaign asks. It is hard to imagine any other public health campaign around drug use—alcohol, say, or even something as stigmatized as fentanyl—referring to people as rats. The hatred and discrimination that’s long existed against people who use combustible tobacco has been transferred to those who want to quit cigarettes through harm reduction.

Crusades against nicotine are usually framed in terms of villains and victims, and both keep changing. The original villain, “Big Tobacco” became “Big Vape,” and now, “Big Nicotine.” The victims used to be people who smoked cigarettes. Now it is those making the healthy decision to switch to a safer nicotine delivery device.

As is always the case in these zealous anti-tobacco harm reduction campaigns, the lies are staggering. Even the campaign’s name—“End Tobacco Damage”—is a lie, when the focus is on products that contain no tobacco and that reduce damage to public health.

“You are part of “Big Nicotine’s experiment,” UNDO states. “Each use makes you part of an experiment with your health at stake.” Nicotine is an “addictive poison.”

Nicotine is not a poison; it is a mild stimulant drug that billions of people have consumed safely over thousands of years. It is used ceremonially, medicinally and recreationally. Moreover, no one who ingests it is being experimented on, because the effects of nicotine have been exhaustively studied. 

Note that people who use nicotine patches and gums are exempt from the label “lab rats,” are not part of an experiment, and aren’t seeing their products targeted for prohibition. Of course, “Big Pharma” sells these over-the-counter “poisons,” better known as nicotine replacement therapies.

The campaign section titled “What this poison can do to you” is so full of demonstrably false assertions that you might spontaneously combust!

Lighting tobacco on fire to get nicotine is the problem. With the invention of vapes, nicotine pouches, snus and heated tobacco products, there are many ways to use the drug that eliminate combustion and work as alternatives that people who smoke actually want to use. This is something to be celebrated, not vilified.

The campaign section titled “What this poison can do to you” is so full of demonstrably false assertions that you might spontaneously combust! Nicotine blocks the brain’s ability to pay attention, it claims. But it’s the opposite; nicotine increases attention and focus. Up next; “Nicotine can deepen depression and amplify anxiety.” It’s the opposite; nicotine has been shown to decrease symptoms of depression and anxiety.

Then UNDO offers this whopper: Nicotine poisons the body; it makes you “nic-sick.” It does not. If it did, no one would use it!

There is a strong whiff of desperation in these ads and videos attacking the use of safer nicotine products. That’s because over a decade of science irrefutably shows they are safer to use by orders of magnitude compared to cigarettes, and are more effective for quitting smoking than patches or gums. But with smoking on the decline, public health groups seek to justify their existence by presenting harm reduction tools as the enemy. Moral panic and funding are easier to generate for the innocent “victims” of youth vaping than for the people who genuinely face severe health risks: the predominantly marginalized populations that still smoke.

Happily, millions of people around the world have ignored offensive disinformation campaigns like this one and made the switch. That makes the forces opposed to tobacco harm reduction angry. Moreover, they hate that people who vape nicotine actually enjoy it. Over time, their drug-panic propaganda has become less effective, so they’ve doubled down on the shock tactics and deception.

Then there is the Food and Drug Administration (FDA), which has authorized vapes, flavored nicotine pouches and snus as “appropriate for the protection of public health.” This fact is conveniently omitted in attack campaigns like UNDO because it undermines all their bald-faced lies.

With the widespread use of snus, which the Swedish government promotes, Sweden has become the world’s first “smoke-free” country. This remarkable human achievement is also ignored.

Because the goal of “Big Tobacco Control” agencies like the California Department of Public Health is the opposite. They want to deny access to safer nicotine products that can save the lives of people who smoke. Who are the real rats?

Screenshot showing detail of UNDO video via YouTube

The post People Who Vape Are Lab Rats, Says California “Public Health” Campaign appeared first on Filter.

She introduced HR 5629 in late 2025. The bill states, “To provide that the final rule of the Department of Health and Human Services titled, ‘Medications for the Treatment of Opioid Use Disorder’ except for the portion of the final rule relating to accreditation of opioid treatment programs, shall have no force or effect.”

SAMHSA’s 2024 final rule sped up the timetable for methadone patients to “earn” take-home medication. It allowed patients to receive up to seven days of take-home doses during the first 14 days of treatment, and to receive 28 doses within a month. When implemented, this has been life-changing for people who would previously have been tied to daily clinic visits, with all the disruption and surveillance that entails.

Houchin’s bill would roll back all of this progress as the opioid-involved overdose crisiscontinues.

SAMHSA’s 2024 made permanent the loosening of restrictions that was temporarily introduced during the COVID-19 pandemic. It additionally allowed patients to be admitted to an opioid treatment program (OTP) without having to show at least a one-year history of opioid dependence, and permitted initiation of treatment with methadone or buprenorphine via telehealth.

Houchin’s bill would roll back all of this progress as the opioid-involved overdose crisis continues.

In March, the House Energy and Commerce Subcommittee on Health held a hearing on the bill. Houchin stated: “Medications like methadone are effective for some, but are also associated with serious risks, including respiratory depression, cardiac complications, potential for misuse and diversion and dangerous interactions with other substances, particularly in today’s environment where illicit drugs are increasingly potent and unpredictable.” She also falsely claimed that methadone-related overdose deaths increased during the pandemic as a result of SAMHSA allowing more take-home medication.

Her statement is classic scaremongering and ignores decades of evidence that show the efficacy of methadone—and crucially, that its use reduces overdose deaths by over 50 percent. The medication is the gold standard of treatment, has been studied for over 40 years, and is used safely by millions of people around the world.

The problem with methadone isn’t diversion or dangerous interactions, it’s accessibility. The medication is locked inside of clinics that make it difficult to enter and to stay in treatment because of rigid rules like daily dosing, constant urine testing, mandatory counseling and limiting take-home medication.

Houchin’s questions insinuated that strict regulations were needed to decrease methadone-involved deaths and stop diversion. Those DEA talking points have been debunked.

At the hearing, Rep. Houchin questioned Dr. Yngvild Olsen, the former director of SAMHSA’s Center for Substance Abuse Treatment, who was centrally involved in writing the updated guidelines. Houchin was openly hostile to Olsen, instructing her to answer questions with only a yes or a no.

Her questions insinuated that strict regulations were needed to decrease methadone-involved overdose deaths and stop diversion. Those Drug Enforcement Administration talking points have been debunked by numerous studies, conducted during and after the pandemic.

Though the updated SAMHSA rules relaxed some restrictive regulations, here’s the catch: They are only recommendations, and are unenforceable. It’s up to each OTP to decide if they want to enact any of them. Many do not, especially when it comes to more take-home bottles.

So why is Rep. Houchin pushing a bill that repeals unenforceable regulations? Her office did not respond to Filter’s requests for comment.

The Drug Policy Alliance is among many organizations that support the updated SAMHSA guidelines and warn of deadly consequences from Houchin’s bill.

“Nullifying these parts of the final rule would have devastating impacts on people trying to access medication by reinstating barriers to treatment.”

“The Drug Policy Alliance opposes HR 5629, which would nullify updated rules that the communities we represent fought for,” Daniel Fishbein, policy manager for DPA’s Office of Federal Affairs, told Filter. “Nullifying these parts of the final rule would have devastating impacts on people trying to access medication across the country by reinstating barriers to treatment for opioid use disorder.”

“Currently, 80 percent of US counties do not have an OTP, meaning many people who are prescribed methadone must travel hours and wait in line just to get one daily dose,” Fishbein continued. “Eliminating take-home doses could make it impossible for someone who relies on this lifesaving medication to continue care—putting people’s recovery at risk, throwing them into painful withdrawal, and potentially driving them back into the illicit market.”

The American Association for the Treatment of Opioid Use Disorder (AATOD), the trade organization that represents OTP interests, submitted a Statement for the Record expressing “serious concerns” about HR 5629. Over 25 organizations signed on.

“We oppose the elimination of the SAMHSA regulations,” AATOD President Mark Parrino told Filter. “The Congresswoman [Houchin] does not seem to like methadone treatment.”

AATOD’s opposition should be seen in light of the fact that updated regulations make it easier for more people to enter treatment, which increases clinic profits. For AATOD, the SAMHSA guidelines don’t really matter; clinics retain total control over patients and a monopoly on the dispensing of methadone.

The American Society of Addiction Medicine sent a conciliatory letter to Rep. Houchin, stating it is ready to work with her and, “collaborative revisions are needed to make HR 5629 great.”

The Legal Action Center sent a strongly worded statement opposing HR 5629 and urged Congress not to pass the legislation. The American Society of Addiction Medicine (ASAM) sent a conciliatory letter directly to Rep. Houchin, stating it is ready to work with her and, “collaborative revisions are needed to make HR 5629 great.” ASAM recommended she endorse the Modernizing Opioid Treatment Access Act, a flawed bill that limits office-based prescribing of methadone to a small group of specialists and would increase racial disparities in access to the medication.

Houchin’s bill is an extraordinary intrusion into the medical practice of providing medication for opioid use disorder. But so are the involvements of SAMSHA; of the DEA, which registers and regulates OTP; and of the 50 State Opioid Treatment Authorities that license clinics and often enact yet more inhumane regulations.

Current regulations in Houchin’s home state of Indiana are among the most restrictive in the nation. The maximum number of take-home methadone doses permitted there is 14. The number of clinics allowed to operate in the Hoosier state is capped at 27. And opening an OTP requires a “certificate of need” demonstrating why it should be opened—which allows not-in-my-back-yard (NIMBY) groups to mobilize against new clinics.

Opioid treatment programs, highly stigmatized and siloed off from mainstream medical care, are vulnerable to attempts by right-wing politicians to repeal even modest reforms.

Houchin voted for the passage of the “One Big Beautiful Bill” that will cut nearly 1 trillion from Medicaid over 10 years. Medicaid is the largest payer for substance use disorder treatment in the United States, and around 40 percent of people with opioid use disorder rely on the program for health coverage.

Opioid treatment programs, because they are highly stigmatized and siloed off from mainstream medical care, are vulnerable to attempts by right-wing politicians like Houchin to repeal even modest reforms and to keep methadone locked in carceral clinics where patients are surveilled and punished for any rule infraction.

The only way to end these legislative attacks on people who take methadone and to free them from opioid treatment prisons is to end the separate and unequal clinic system, allow all health care providers to prescribe methadone, and integrate the medication into health care and community settings.  

Photograph by Helen Redmond

The Influence Foundation, which operates Filter, previously received a restricted grant from DPA. Filter‘s Editorial Independence Policy applies.

The post Federal Bill Would Roll Back Modest Progress on Methadone Access appeared first on Filter.

Some jails already permitted this, as well as Pennsylvania’s state prisons. But facilities run by the Oklahoma Department of Corrections (ODOC) are just the second prison system in the United States to do so. ODOC began rolling out the plan in early March.

This change is of enormous importance because smoking prevalence is much higher in incarcerated populations than in the general population. It’s estimated that 70–80 percent of people incarcerated in the US smoke.

Few are allowed to smoke in prisons, due to widespread bans. 

The Federal Bureau of Prisons removed tobacco from prison commissaries in 2006 and nine years later, officially instituted rules prohibiting smoking and possession of tobacco. Most states have also implemented prison tobacco bans; Oklahoma did so in 2005 (though it reversed this for minimum-security prisons in 2010).

But plenty of prisoners continue to smoke despite the bans, taking significant risks in the process. And nearly all of those who quit out of necessity will resume smoking upon release.

“After discussions with Oklahoma leadership and stakeholders, we started offering nicotine vapes and pouches for purchase at the commissary at the beginning of March.”

Before the bans were enacted, tobacco was a form of currency. Afterwards, it was contraband. Possession became a disciplinary infraction, and many who buy contraband tobacco at inflated prices in prisons accumulate tobacco debt.

“Debt equals violence in prison,” ODOC Director Justin Farris told a local news reporter of his department’s decision to allow safer nicotine products. “We are thinking we are going to reduce some of the contraband that comes into the prison and reduce some of the violence at the same time and keep a lot of these guys out of debt.”

“After discussions with Oklahoma leadership and stakeholders, we started offering nicotine vapes and pouches for purchase at the commissary for both staff and inmates at the beginning of March,” Kay Thompson, ODOC’s chief of public relations, told Filter via email.

In 2025, Thompson added, ODOC seized 1,614 pounds of contraband tobacco.

A single disposable vape in an Oklahoma prison costs $11.50. Unfortunately, only tobacco and menthol flavors are allowed. Nicotine pouches, meanwhile, are available in Chewy Watermelon, Glacial Mint or Wintergreen flavors, and a pack of 21 costs $10.50.

Though ODOC officials highlight the violence-reduction potential of safer nicotine products in this environment—according to the local media report, they hope these will “calm” prisoners—they don’t emphasize the essential fact that vapes and pouches are much safer than cigarettes in terms of health risks.

Money is a factor, too, and it is regrettable that the products won’t be available at lower cost or even free. According to Thompson, the ODOC receives a 20 percent commission on each sale. But she said that money will go into a fund to help employees and prisoners, with dedicated uses such as purchasing hygiene supplies for those who can’t afford them.

It is about the right to health for prisoners who use nicotine.

The vapes are supplied by Jail Puff, whose tagline is: “Changing corrections one puff at a time.” The company website explains how its vapes are equipped with tamper-proof and adhesive security seals. Jail Puff also offers prisons free tracking software that “allows for efficient monitoring and accountability, ensuring the utmost security and compliance with regulations.” The flavored nicotine pouches are supplied by Hyppe and 2ONE.

Having vapes and nicotine pouches available in prisons, as is the case in the United Kingdom, provides an alternative to the dangers of the contraband tobacco market. But it’s also a long-term opportunity to avoid smoking-related disease and death. It is about the right to health for prisoners who use nicotine.

Incarcerated reporter Jonathan Kirkpatrick authored a series of Filter articles calling for safer nicotine products in all carceral settings. “From a purely harm reduction standpoint it makes sense to offer these prisoners the chance to develop a new, safer practice of nicotine use,” he wrote. “Like many habits acquired in prison, it’s one they might very well take back to the streets with them. If so, they’d be likely to live longer, healthier lives.” 

Photograph of available products courtesy of ODOC

The post Oklahoma Prisoners Can Now Buy “Jail Puff” Vapes and Pouches appeared first on Filter.

For people with opioid use disorder, taking methadone lowers the risk of overdose by 59 percent over the first year. The ongoing opioid-involved overdose crisis means it’s critical that people are able to continue with this lifesaving treatment.

But that isn’t what the researchers found. Instead, the study revealed, “the median OTP [opioid treatment program] had 30-day, 90-day, and 180-day retention rates of 61.2%, 41.5%, and 27.5%, respectively.”

Individual clinics’ retention rates varied considerably. But in approximately half of them, at least one-third of patients had left within 30 days of starting treatment. Still more leave as treatment continues. At most clinics, most patients don’t make it to three months. It is an unacceptable health care delivery failure.

The study looked exclusively at Medicaid beneficiaries, analyzing data for over a quarter of a million individuals from 2018-2023. Medicaid is the largest payer for methadone; it’s estimated that 75 percent of patients have coverage through this program.

People who take methadone are forced to make the clinic and its inhumane culture a daily part of their lives. This is what leads to high drop-out rates, perpetuating the overdose crisis.

“This study found that there is considerable room for improvement in OTP retention rates,” the researchers wrote. That’s an understatement! The clinic system is costing lives by forcing large numbers of people to turn back to the dangerously adulterated unregulated drug supply. 

The researchers cite a number of problems with clinics that help cause this, all of which have been documented for many years: inadequate dosing, long travel times and the stigma associated with taking methadone. These hint at what stands in the way of people remaining in treatment: The culture of cruelty that is foundational to how clinics operate.

Entering methadone treatment is a uniquely traumatic experience. Patients wait in long lines outside the clinic in all kinds of inclement weather. It’s humiliating. They are treated like criminals, and aren’t trusted to take their medication without a nurse watching. Every single time. It’s called “supervised dosing.” There are “observed urines,” meaning staff watch patients pee or a video camera records it, as part of a regimen of drug testing. Positive screens can lead to sanctions including denial of medication.

Commuting to an OTP six or seven days a week is an enormous and expensive extraction of patients’ time. This leads to missed doses and counseling appointments, as well as damaging disruptions to people’s lives in terms of work, educational or caretaking commitments.

Take-home medication has to be “earned,” which can take years, and it can be taken away for a raft of reasons. There is mandatory counseling with a constantly changing cast of counselors. Patients are punished for even the smallest rule infractions.

People who take methadone are forced to make the clinic and its inhumane culture a daily part of their lives. This is what leads to high drop-out rates, perpetuating the overdose crisis.

The way to boost treatment retention rates and save lives is to end the OTP monopoly over the dispensing of methadone. All health care providers should be able to prescribe the lifesaving medication in office-based and community settings—including at syringe service programs, overdose prevention sites, drug treatment programs, hospitals and outpatient clinics.

Photograph by Helen Redmond

The post Methadone Clinics to Blame for Unacceptable Drop-Out Rates appeared first on Filter.

“We will provide expert guidance and support to policymakers, health care organizations and funders to improve access to methadone,” Fiellin told Filter.

How likely is the commission to make methadone more accessible?

In a January 28 press release following the commission’s first in-person meeting in New York, FORE President Dr. Karen A. Scott said the commission would bring together “diverse experts and voices.” But a look at who was appointed reveals that it’s stacked with methadone clinic operatives and defenders.

Dr. Robert Sherrick is the chief science officer for Community Medical Services, a national opioid treatment program (OTP) chain. Dr. Kenneth Stoller is the director of the Johns Hopkins Broadway Center for Addiction, an OTP in Maryland.  Dr. Michelle Lofwall is the medical director of the Robert Straus and First Bridge Clinics in Kentucky. Dr. Malik Burnett is the medical director of several clinics in Maryland and Zachary Talbott is the owner of Talbott Legacy Centers, an OTP in Tennessee. At a Mount Sinai methadone clinic in New York City, Anita Kennedy is employed as a peer engagement specialist. 

Notably, among the commission’s “diverse voices,” not a single member advocates for clinic abolitionin favor of pharmacy pickup for all.

Kennedy and Talbott take methadone, and Fiellin said, “It’s important for us to have former or current patients who can speak to their direct experience. Both have been part of the largest patient organization, the National Alliance for Medication Assisted Recovery [NAMA-R].”

When I pointed out that both also have a conflict of interest, Fiellin wasn’t concerned. “They have intimate knowledge and experience in these complicated settings that is important to inform the work of the commission.”

The American Association for the Treatment of Opioid Addiction (AATOD)—a  trade group that seeks to preserve clinics’ stranglehold on methadone by blocking meaningful reform—will exert major influence on the commission.

Stoller is a current board member. Talbott is a former member of the Georgia state chapter. He is also the past president of NAMA-R—a position currently occupied by Kennedy. NAMA-R has a collaborative relationship with AATOD, hosting methadone advocacy training at its annual conferences. Sherrick is a regular presenter at the conference, and in 2025 made the case for implementing a few token reforms in order to stave off changes that could end clinics’ monopoly on methadone dispensing. Fiellin, Talbott and Kennedy have also received awards from AATOD. Kennedy did not respond to Filter’s request for comment.

Another member of the commission is a former diversion investigator for the Drug Enforcement Administration (DEA), Denise Curry. She was involved in the negotiation of a national voluntary restriction on retail sales of methadone.

That’s not to say the commission includes no reform advocates who acknowledge certain fundamental problems with the clinic system.

“I’m in favor of fixing the broken aspects of the clinic system. It is broken by regulatory design and by a racialized history of drug policy.”

“We all love methadone. We think it’s a lifesaver,” Beth Meyerson, a professor of nursing and the director of the Harm Reduction Research Lab at the University of Arizona,” told Filter.

“I’m in favor of fixing the broken aspects of the clinic system,” she continued. “It is broken by regulatory design and by a racialized history of drug policy. We know the current system is not working well and we could do better.”

To help the system work better, Meyerson’s university received a 4.5 million grant from the National Institute on Drug Abuse to test an intervention to reduce OTP staff stress and improve patient retention.

But notably, among the commission’s “diverse voices,” not a single member advocates for clinic abolition in favor of pharmacy pickup for all, as with any other medication.

Over the last 50 years, several advisory bodies have examined OTP regulations and offered a series of recommendations. But nothing fundamental has ever changed.

A 1983 review by the Reagan-administration Department of Health and Human Services noted the inflexibility of federal methadone regulations and their failure to keep pace with the “state of the art” in an evolving field. Nothing changed.

In 1995 the Institute of Medicine convened the Committee on Federal Regulation of Methadone.It advocated for reducing strict federal oversight to improve access and moving to a model of “patient-centered care.” The committee, its report stated,“regards the current regulations as unreasonably extensive and intrusive, and finds no compelling medical reason for regulating the therapeutic use of methadone differently from any other Schedule II controlled substance.”  But nothing changed.

Zoom up to COVID-19. The pandemic forced clinics to implement emergency measures to keep patients and staff safe from infection. Take-home medication, which is strictly controlled, was suddenly made more available. All patients were screened to receive 14 or 28 days of methadone.This rule relaxation was unprecedented. More take-homes didn’t lead to an increase in diversion or overdose deaths—two reasons often cited for denying them.

The central problem is an implicit consensus that the 50-year-old model of methadone dispensing is still relevant and needed, albeit with tweaks to make it less cruel and dysfunctional.

As a result, space opened up to discuss OTP reform again. In 2022, the National Academies of Sciences, Engineering, and Medicine (NASEM) hosted a webinar, “Methadone Treatment for Opioid Use Disorder: Examining Federal Regulations and Laws.” Over two days, dozens of presenters—from academics and doctors to a DEA administrator and the president of AATOD—discussed longstanding problems in the clinic system. 

Policy recommendations were remarkably similar to previous ones: deregulation and “patient-centered” care. But this time, there was direct criticism of clinics’ carceral structure by people with lived experience. 

One speaker asserted that clinics are a creation of the drug war. Joy Rucker, former executive director of the Texas Harm Reduction Alliance, was blunt: “Methadone has been used as a social control mechanism throughout the years and that is why we have all these barriers to access. That is what needs to change.” 

Several speakers proposed office-based treatment, pharmacy pickup and the integration of opioid use disorder treatment into the medical system. Yet despite these bold proposals to free methadone, no changes occurred. 

Following the NASEM webinar, 2023 saw a two-day conference titled “Liberating Methadone: Building a Roadmap & Community for Change,” organized by the National Coalition to Liberate Methadone. The first day focused on research opportunities. Methadone has been studied for decades. There isn’t a need for more research on treatment barriers, which are well documented. The second day was a series of panels that included a representative from the Substance Abuse and Mental Health Services Administration (SAMHSA), the administrative director of a methadone clinic, physicians, lawyers and people who take methadone. But advocates for clinic abolition were not featured on any panels. 

The post-conference report’s recommendations included ending the culture of cruelty, promoting a “person-centered approach,” centering lived and living experience, and allowing physicians to prescribe methadone in office-based settings for pharmacy pickup—remarkably similar to what came out of the 2022 NASEM event.

The central problem with these OTP reform advisory bodies is an implicit consensus that the 50-year-old model of methadone dispensing is still relevant and needed, albeit with tweaks to make it less cruel and dysfunctional. They advocate for voluntary, incremental changes that loosen the liquid handcuffs for a few “model methadone patients” but don’t truly threaten the status quo.

Bill Kinkle, a harm reductionist and nurse with lived experience of the harms of the methadone system, is clear-eyed about why. “It does not benefit the gatekeepers of methadone,” he told Filter, “to liberate the one medication that will stop the overdose crisis and bring meaningful and long-lasting freedom from opioid treatment prisons.”

Some members of the new commission at Yale call for maintaining OTP and allowing office-based prescribing. “I don’t think it’s an either-or,” Meyerson said. “I’m in favor of normalizing methadone access, which involves system evolution so that any prescriber can manage their patients on the medication. But I’m also in favor of clinics that will fill the gap. We really need to think about how the system evolves and that there is a safety net, so there aren’t people living in an area with no provider who will treat them and no clinic.”

This position, while promising a better future for some patients with access to office-based prescribing, leaves the structurally racist, carceral clinic system intact.

How can anyone believe that the creators and beneficiaries of the carceral methadone clinic system can be the ones to fix it?

It’s also a nonstarter for any commission dominated by OTP operatives and AATOD members. Why would they ever voluntarily give up their profitable, cartel-like control of the methadone market? For the methadone mafia, real reform equals extinction, and they will fight that through well-funded lobbying campaigns and their longstanding relationships with the DEA and SAMHSA.

Fierce AATOD opposition to the Modernizing Opioid Treatment Access Act is a recent example—unrelenting and full of fearmongering lies. The bill, which was seriously flawed as it only allowed non-clinic prescribing by a small group of addiction medicine specialists, never went anywhere.

“We want to facilitate substantive change, and especially given the unique role that methadone can play in an environment where almost everybody with opioid use disorder is using fentanyl,” Fiellin said. “We recognize that the previous restrictions don’t meet the current public health needs.”

Fiellin’s comment doesn’t promise real accountability for countless fentanyl-involved overdose deaths facilitated by a system that excludes and punishes.

It’s criminal that clinics’ restrictive regulations have still not been eliminated after successive waves of the opioid-involved overdose crisis. This epic failure to save lives means that the DEA, SAMHSA, AATOD and the OTP owners that have fought against change have blood on their hands.

How can anyone believe that the creators and beneficiaries of the carceral methadone clinic system can be the ones to fix it? 

Photograph (cropped) of commission members courtesy of FORE

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