“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.

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.

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.

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

The post Commission to Look at Methadone Regs, But Don’t Hold Your Breath appeared first on Filter.

Communities engaged in NIMBY protests against opioid treatment programs (OTP) from New York to North Dakota have a tried-and-true template: They are a threat to children and families, increase crime, attract drug dealers and decrease quality of life. And always, This isn’t the right location for an OTP; somewhere else is. Except there is no somewhere else. No neighborhood welcomes a methadone clinic, and nothing unites a community faster than when one tries to open its doors. 

I met Fab 5 Freddy, the host of Yo! MTV Raps, hip-hop pioneer, artist and filmmaker, at the press conference a few blocks from where I live in Harlem. He wore a black T-shirt that said “Harlem American” and a broad-brimmed pork pie hat. It was a sunny day in August 2018. A Who’s Who group of local politicians, wearing crisp light blue and brown suits and ties, stood behind a podium. About 20 members of the neighborhood were arranged behind them on the sidewalk. The local media set up video cameras on tripods and clipped microphones to the podium. Everyone was assembled to celebrate that they had stopped a methadone clinic from opening in a historic brownstone. 

A woman representing the Sugar Hill Concerned Neighbors Group described how they mobilized a hundred people within two days to attend a meeting with Argus, the corporation that planned to open the clinic and had paid $4.3 million for the property. She asked, “Who would want to live next to a methadone clinic?” 

“We’re not anti the people who need these services. Just not here.” 

Another speaker explained that Sugar Hill was a family community of brownstones and therefore it was the wrong location for a clinic. Speakers were mindful to say they cared about people struggling with an addiction and that it wasn’t “pushing back at the lesser of us.” 

Al Taylor (D), a reverend and state assembly member who represents Harlem said, “We’re not anti the people who need these services. Just not here.” 

Adriano Espaillat (D), a United States representative whose congressional district includes Harlem, asserted, “This isn’t a not-in-my-backyard thing. We need to have empathy.” He added that the neighborhood wanted to keep its quality of life and that Argus should look for another location. Espaillat suggested the Upper East Side of Manhattan. 

Then he smiled and called everyone involved in the fight the “Sugar Hill Gang.” The crowd broke into laughter. 

Several speakers asserted Harlem was oversaturated with methadone clinics, and thousands of people were commuting in from other boroughs. It wasn’t fair, they said. The press conference ended with another elected official commending everyone and cautioning, “We must stay united. One finger you do nothing. With a fist, you can win. We won!” 

After the press conference, I approached Fab 5 Freddy. I wanted to ask him why he opposed the methadone clinic, and he agreed to an interview. In front of the Kingdom Hall Of Jehovah’s Witnesses, Fab explained that for 20 years he has lived in a brownstone about a block from where Argus wanted to open the OTP. Over that time, he saw the neighborhood change for the better. 

I assured him that no one wanted to travel to a clinic in Harlem six days a week … The solution was to let all patients pick up a prescription at a pharmacy in their neighborhood.

He said that Sugar Hill was damaged by open drug dealing and drug use for decades: “The neighborhood has gone through a lot of trauma, and we don’t want to see something that could take us back there.” He was not a fan of methadone and said, “I’m not a doctor, but I don’t think methadone is the best treatment. It keeps them caught up in an addictive state.” 

During the conversation, Fab was easily convinced that methadone was a lifesaving maintenance medication and that the problem was the clinic system. I assured him that no one wanted to travel to a clinic in Harlem six days a week and stand in a line to get dosed. The solution was to shut down OTP and let all patients pick up a prescription once a month at a pharmacy in their neighborhood. It was a light-bulb moment for Fab. 

NIMBY movements use a number of strategies and tactics to keep clinics out. One of Dr. Beny Primm’s greatest frustrations was the community opposition he encountered whenever he tried to open an OTP in Harlem or Brooklyn in the 1970s and ‘80s. 

Primm, the late pioneer in addiction medicine, HIV research and public health advocacy, said, “It seemed that there were people who would use any means to block us … We found a building at 145th Street and Eighth Avenue and began renovations for a clinic. The building was set on fire. We brought guard dogs to the location and they killed the dogs.” Primm suspected that a drug-free organization in Harlem was responsible. The clinic never opened. 

A Lynnwood council member said during a 2023 hearing, “We can’t sacrifice the safety of our children.”

Residents from the city of Lynnwood in Washington State launched a fight against Acadia Healthcare, the largest methadone provider in the state, to block a clinic from opening in 2023. They were angry that it was near the Boys & Girls Club building. They formed a group called Safe Lynnwood and organized a protest march to the site where the OTP would open. 

At a city council meeting, an older woman told a representative from Acadia that he should be ashamed to open a clinic near the Boys & Girls Club. A city council member said during a hearing, “We can’t sacrifice the safety of our children.” Another official added, “If a single child is injured as a result, what is the price for that single child being injured due to the location of this facility?” 

The obsessive focus on “the children” and the perceived harm that a clinic could cause has no basis in reality. There is no evidence that OTPs make a neighborhood unsafe for children. Are the people who promote these hateful ideas aware that thousands of methadone patients are parents? 

As is common when an OTP wants to open a clinic, Arcadia submitted a written response to address community safety concerns and to explain how a clinic operates. They clarified it would only be open six hours a day, about 140 patients per day would be medicated, and all dosing would be completed by 11:30 am. Arcadia assured the community that patients receive counseling. 

To assuage community fears, methadone clinics promise to police and punish patients.

For security, the OTP would employ guards during and after operating hours to deter loitering at the facility or surrounding areas. Patients would be told loitering would not be tolerated and any illegal activity would be immediately reported to the police. 

To assuage community fears, methadone clinics promise to police and punish patients. They hype that security guards and video cameras will surveil them constantly inside and outside the clinic. They’ll only provide narrow windows of time when people can get medicated to assure the community that those people will only be in the area for a short time. If caught lingering, patients will be penalized. 

These carceral concessions to NIMBY groups further criminalize patients, reinforce discrimination and create hardships. For decades, patients have complained about the limited hours OTPs are open, which contributes to missing doses, being late for work or school, and not being able to take care of life responsibilities. 

Clinic owners focus on reducing and penalizing “loitering” because they believe that it triggers community complaints, so they want patients to get medicated and get out—dose and dash! It’s an iteration of the sundown town. 

The Family Guidance Center OTP in Chicago has a sign on the entrance door that threatens: “If you are seen loitering or lingering around the building or the surrounding area, you will immediately be placed on involuntary withdrawal.” The clinic is in a Black neighborhood that has gentrified and it’s a few blocks from Magnificent Mile, a luxury shopping district on Michigan Avenue.   

This article is excerpted with permission from Liquid Handcuffs: Policing and Punishment in Methadone Clinics and the Future of Opioid Addiction Treatment—the new book by Helen Redmond, published by North Atlantic Books. The book is available in paperback and ebook formats as of March 3.

A panel event to launch the book will be held in New York City on March 5. Tickets are free but can be reserved here. 

Top photograph (cropped) by Jaime Fearer via Flickr/Creative Commons 2.0 

Image of book cover courtesy of North Atlantic Books

The post “Would You Want to Live Next to a Clinic?”—Methadone NIMBYism appeared first on Filter.

As the company Opio puts it, “OTPs haven’t evolved with the rest of healthcare … The tech sector left opioid treatment programs behind. Until now.”

Methadone tech companies are showcased in the cavernous exhibition hall at the annual American Association for the Treatment of Opioid Addiction Dependence (AATOD) conference. Like MethaSpense, offering dispensing machines; Methasoft, with software that measures and tracks every drop of medication; and Sonara, which created the “Virtual Dosing Window”—actually an in-home patient policing tool. New businesses, masquerading as “patient-centered,” are keen to join the methadone-industrial complex.

Opio also had a display at the 2025 event, with the tagline: “Unlock bold new possibilities.” Enclosed in a large glass cubicle was a computer, connected to a jumble of machinery and piles of plastic bottles and caps. It was called ZING.

The rep told me ZING was a stand-alone robotic dose assembly machine that connects to a clinic’s existing methadone dispensing system. It measures, pumps, caps, seals, labels and photographs each dose. The machine can fill 28 bottles in about 4 minutes. According to the Opio website, “ZING robotic technology revolutionizes methadone dose assembly, allowing clinics to optimize staffing, support nurses, and increase patient capacity.”

“Every time a nurse is placing, filling, capping, sealing they’re not thinking about the human being who is standing right in front of them.”

ZING is promoted as the solution to a nursing shortage. High staff turnover rates in OTPs lead to long lines, for patients who dose daily and those who have “earned” take-home medication.

“Every time a nurse is placing, filling, capping, sealing they’re not thinking about the human being who is standing right in front of them,” said Dustin Mets, the CEO of Ohio OTP CompDrug, in a video promotion for ZING. That’s an astonishing admission.

“I think the Association for Behavioral Health in Massachusetts reported 80 to 100 percent turnover in nursing positions in OTPs,” Sam Wilson, Opio’s co-founder and COO, told Filter. “So it’s very costly and it provides a pretty poor patient experience when the nurse is changing so frequently. It’s very difficult for them to build relationships.”

Bill Kinkle, an RN who has taken methadone, has firsthand experience of that. “On Saturdays the line would be backed up because the nurse filled each bottle for each client at the dosing window,” he told Filter. “People with seven or 14 take-homes had to wait for the dispensing machine to spit out the methadone in each bottle. Nurses then printed and sealed each bottle, plus writing the number on each cap. It’s so time-consuming.”

Nurses play a critical role at OTPS; if they don’t “run the pumps”  or prepare the “pre-pours” (take-home doses), patients don’t get methadone and Medicaid isn’t billed. But they’re working in a setting unlike any other—a carceral environment, designed by the Drug Enforcement Administration (DEA), where they have almost total power over patients.

The clinic structure pits nurses—stationed behind thick, bulletproof plexiglass—against patients, who are viewed as untrustworthy criminals. A nurse’s job consists of programming a MethaSpense machine to fill a plastic cup with one dose of methadone, pushing it through a hole in the plexiglass, and observing patients swallowing it. Then they ask the patient to speak or lift up their tongue to ensure ingestion. This is what nurses do all day, every day.

OTPs operate like a factory assembly line, where nurses might medicate up to 1,000 patients or more daily. It’s a stressful environment for everyone. In these “dose and dash” circumstances, it’s almost impossible for nurses to have meaningful human interactions with patients. Is it any wonder so many quit?

It frustrates Kinkle. “OTPs are a gaping sore in the nursing field,” he said. “They’re essentially penalty boxes for nurses who aren’t trusted to work anywhere else.”

A robotic machine that fills bottles as fast as lightning doesn’t fundamentally change the relationship between nurses and patients.

If ZING frees nurses from the monotonous filling of thousands of pre-pours and shortens patient wait times, that’s a positive. It will be particularly important if OTPs follow the updated guidelines from the Substance Abuse and Mental Health Services Administration guidelines to allow far more take-homes from Day One.

But a robotic machine that fills bottles as fast as lightning doesn’t fundamentally change the relationship between nurses and patients. That’s why it won’t, as Opio claims, “let nurses be nurses.”

Nurses play a central role in clinics’ culture of cruelty. They police and punish patients for rule violations like failing to respond in time for a bottle recall, and rescind take-homes for positive urine screens or even if a lid on a single bottle doesn’t “look right.”

“We would lock the doors at 2 pm and were discouraged from letting a patient in late,” one former clinic nurse recounted, “even if they were running across the parking lot to make it in the door before the clinic closed.”

It’s not just inhumane, but medical malpractice. Missed doses set patients up to buy adulterated fentanyl on the street, risking overdose and death.

Opio has developed another product. ZING Satellite is a telehealth booth linked to the ZING robotic dose assembly machine. It can be placed within federally qualified health centers, pharmacies, hospitals or correctional facilities.

“I worked in a hospital setting as a clinical pharmacist in Montana in a neonatal intensive care unit,” Amber Norbeck, Opio’s co-founder and CEO, told Filter. “Part of my job was to help moms get treatment, but it was really hard because there’s only four methadone clinics in the state. Drive times and access is an issue.”

“I was also serving other rural hospitals remotely through technology after hours,” she continued, “and I thought, if I can serve another hospital remotely through dose verification and remote dispensing, why can’t we apply similar technology to the opioid treatment space? We can solve the geographic access gap. So that’s how this company was founded.”

Every step in the dosing process is tracked, traced and timestamped; a camera records the entire interaction.

This is how ZING Satellite works: A patient enters a booth or room and their eyes are scanned using IrisID to confirm their identity. Opio boasts that it’s the same technology used by airport security. A nurse located remotely in an OTP, usually in the same state, starts the virtual dosing session by verifying patient information and then directs the machine to fill either one dose of methadone or a number of take-home bottles. The patient signs a touch screen, then the nurse remotely unlocks a secure transfer drawer. The bottle is collected and the nurse watches while the patient swallows the liquid.

Every step in the dosing process is tracked, traced and timestamped; a camera records the entire interaction. The DEA, obsessed with surveillance and diversion-control, has approved ZING Satellite use in several states.

The National Institute on Drug Abuse contributed funding for the development of ZING Satellite to expand methadone “access points,” and they’ll be available in 2026 for a monthly rental fee of $2,995 plus software and setup fees. The ZING unit alone costs $300,000, though AATOD members get a price drop to $225,000.

“ZING Satellite will be registered as a satellite medication unit of an existing OTP. It replicates the entire experience at the dosing window,” Wilson said. “The way that this technology is designed is so that one nurse can be serving multiple remote ZING Satellite locations at the same time. And while ZING is assembling the take-homes, they could greet another patient in another area. It’s creating the maximum usage of the workforce to create access points in areas where we know from conversations with our OTP customers that they can’t sustain a business operation in more rural areas.”

In other words, OTPs can’t make enough money serving small, rural communities. ZING Satellite is a smaller investment than a brick-and-mortar facility, allowing a few nurses to medicate dozens of patients virtually and boost profits.

There is something profoundly alienating about providing virtual dosing to dozens of patients at the same time, as each stands alone in a remote location. It’s a virtual assembly line, with patients medicated by a robot under constant DEA-endorsed monitoring.

Opioid treatment programs don’t need yet more humiliating patient surveillance technology. Instead, clinics need to be shut down.

Like clinics themselves, Zing Satellite amounts to separate and unequal treatment. Can you imagine any other medication being dispensed in this stigmatizing way? And if patients have to dose daily in ZING Satellite, the convenience factor is eliminated and getting to it becomes the centerpiece of their lives.

There is a dangerous lack of access to opioid use disorder medications in rural areas. Opio’s lucrative plan to fill this gap is to place Zing Satellite in locations such as rural hospitals or clinics all over the US. Yet it’s a ludicrously convoluted and expensive response to a problem that has a simple, accessible solution.

“It is a completely unnecessary piece of tech because methadone doesn’t need to be locked away in a clinic or in liquid form,” Kinkle said. “If it was available like every other medication in pill or wafer form, all that precious time nurses would like to use being with patients could be used in other outpatient areas.”

Wilson explained that the name ZING comes from the word “moderniZING.” But opioid treatment programs don’t need yet more humiliating patient surveillance technology. Instead, clinics need to be shut down, which would make the nursing shortage a non-issue.

Every patient should be able to pick up a prescription of methadone the good old-fashioned, nonstigmatiZING way—at a community pharmacy once a month.

Photographs courtesy of Opio

The post Robotic Methadone Tech Not the Answer to Clinics’ Culture of Cruelty appeared first on Filter.

How credible were the conference’s promises of evolution toward harm reduction? And what’s behind the change of tone?

Lest we forget, a global pandemic was required to force AATOD, the trade organization for opioid treatment programs (OTP, or methadone clinics), to consider “evolving” harsh clinic regulations that had been in place for over 50 years. COVID-19 had a multiplier effect, compelling the Substance Abuse and Mental Health Services Administration (SAMHSA) to update clinic guidelines, and State Opioid Treatment Authorities to re-evaluate their often stricter rules. Mainstream media began to expose the numerous barriers to methadone access, and the New York Times investigated alleged fraud at Acadia Healthcare, one of the largest for-profit OTP chains.

Senator Donald Norcross (D- NJ) proposed the Modernizing Opioid Treatment Access Act (MOTAA), to allow a small group of board-certified addiction doctors to prescribe methadone outside of the clinic system. Norcross lashed out: “We must end the monopoly on this life-saving medicine that only serves to enrich a cartel of for-profit clinics and stigmatize patients.”

For the first time ever, in other words, AATOD confronted the prospect that its methadone monopoly might end. Post-pandemic, frantic cartel bosses had to figure out a way to head off fundamental change while appearing to evolve from a deeply embedded culture of cruelty into “patient-centered care” and “shared decision-making.”

What a difference three years makes! AATOD is no longer panicking. Yet the vibe in the methadone industry has palpably shifted.

In 2022, I attended the AATOD conference in Baltimore. The old guard doubled down to defend the status quo. There was an arrogant insistence that rigid clinic regulations were necessary and no reforms were needed post-pandemic. The biggest focus was (MOTAA) and mobilizing to kill the bill. Jason Kletter, the fear-mongering president of OTP operator BayMark, asserted that pharmacy methadone pick-up was “dangerous” for patients and communities. He dismissed harm reduction principles and practices as “extreme.”

What a difference three years makes! AATOD is no longer panicking. Norcross’s bill is stalled in the Senate, dead for now, and there are no new calls for clinic reform. The media have moved on, amid the Trumpian chaos. Yet the vibe in the methadone industry has palpably shifted.

There was a sense in the workshops I attended that incremental change was needed, and that harm reduction wasn’t extreme. There were even admissions from OTP staff that hinted at the cruelty of clinics.

AATOD President Mark Parrino

John Hamilton, the genial CEO of Liberation Programs in Connecticut, hosted the hot topic roundtable, “Integrating Harm Reduction and Medication Assisted Treatment.” He declared, “With a philosophy of love we can make so much change … It isn’t us versus them.” Hamilton roamed the room Oprah–style, mic in hand, inviting people to share thoughts. One of the most damning disclosures came from Linda Hurley, the CEO of Codac Behavioral Health Care in Rhode Island, who has worked in drug treatment for 30 years and is an AATOD board member. She declared, “We have been paramilitary; no more paramilitary!”

Then Hamilton handed me the mic. I said I was a clinic abolitionist and believed all health care providers should be able to write a prescription for methadone that could be picked up at a pharmacy. I got a round of applause! What? Was I really at the AATOD conference?

The biggest conundrum now for clinics is how to give more take-home medication. Their default position has always been blanket refusal in favor of daily on-site dosing.

But don’t be fooled. Workshops that focused on the “challenge” of implementing new SAMHSA guidelines revealed the true motives for AATOD’s evolution, and they have nothing to do with love.

The biggest conundrum now for clinics is how to give more take-home medication. Their default position has always been blanket refusal in favor of daily on-site dosing, to maintain control over patients in the name of stopping diversion and to protect profits.

But research conducted during the pandemic irrefutably showed that giving additional take-home medication didn’t result in an increase in diversion or overdose. In 2024, SAMHSA issued a Final Rule making some COVID relaxations permanent—allowing eligible patients to receive up to 28 days of take-homes after their first month of treatment. So there’s pressure to allow more take-homes for patients who meet the SAMHSA criteria.

Image via SAMHSA

But if clinics are reduced to mere bottle-refill stations—grab your month’s doses and dash—how can they maintain the illusion that their on-site services and surveillance justify their methadone monopoly? Why not just let people pick it up from pharmacies?

In one session, Dr. Robert Sherrick, the chief science officer for Community Medical Services (CMS), which owns 70 clinics in 13 states, reviewed changes in SAMHSA’s take-homes policy. He made it clear that the medical director still decides the number of “take-home allowances.” There was no pretense of shared decision-making. “CMS has implemented a triweekly dosing schedule in states where the regulations allow,” Sherrick said, adding that daily clinic visits are still necessary for some patients for their safety.

Triweekly dosing is better than six or seven, but it’s stingy compared to what the Final Rule allows. One of Sherrick’s slides acknowledged that daily dosing is a burden for patients, but so is triweekly. It means patients must continue to make CMS the center of their lives.

The last two points say it all: Clinics should allow some take-homes, to resist further loosening of regulations and avoid losing control as they fight to maintain their survival.

Sherrick explained how staff use SAMHSA’s updated six-point criteria to determine if a patient qualifies for take-homes. These include the absence of serious behavioral problems, problematic substance use or diversion, plus regular attendance and the ability to store methadone safely. These criteria discriminate against certain patients, particularly those who are unhoused. And the way they are wide open to interpretation allows for the denial of take-home bottles for almost any reason.

Random “medication callbacks” continue, Sherrick stated, because, “The DEA likes to see that.” His final slide posed a question:

The last two points say it all: Clinics should allow some take-homes in order to resist further loosening of regulations, stop MOTAA or the pharmacy pickup advocated by the Methadone Manifesto, and avoid losing control as they fight to maintain their own survival.

Another workshop grappled with unsupervised dosing under SAMHSA’s Final Rule. Staff from the Behavioral Health Network (BHN) in Massachusetts described a complicated workflow and assessment tools they’ve developed, which evaluate stability, safety, drug use and factors regarded as protective like having a job, family and clinic attendance.

At BHN, a positive drug test now doesn’t automatically mean a loss of take-homes. This is a positive change. The speakers claimed their decision-making process was based in the philosophy of harm reduction, promoting their tools as a shift from punishment to safety.

But no patients were involved in the creation of these tools, which ignores a core harm reduction principle. And rescinding or reducing the amount of take-home bottles, which remains a central feature of the BHN model, is punishment, no matter how much they reframe it as “safety.”

“Incorporating harm reduction strategies, such as giving out naloxone, doesn’t make you a harm reductionist … It has to include the whole philosophy.”

“Incorporating harm reduction strategies, such as giving out fentanyl test strips and naloxone, doesn’t make you a harm reductionist,” Dr. Kelly S. Ramsey, board certified in addiction medicine and a former OTP medical director, told Filter. “If harm reduction is going to be adopted in clinics, it has to include the whole philosophy of harm reduction, which is about dignity and respect for people who use drugs, and social justice. It’s about incorporating people who use drugs in decision-making … Unless all that is happening, they’re not truly integrating harm reduction.”

The BHN staff and others at the conference naively suggest it’s possible to incorporate harm reduction into the carceral clinic system, with a massive power differential between staff and patients at its heart.

Dr. Ari Kriegsman, the medical director of the BHN clinic in Springfield, asserted, “Take-homes aren’t a privilege, they’re a right.”

So if they’re a right, why is a multi-disciplinary team deciding how many bottles a patient can get? Despite reforms easing some of the harshest regulations some of the time, punishment and coercion are foundational to the system. Take-home “rights” can change or end at any time.

“I get take-home bottles, but that’s because I’m not using drugs now. That would end if I started to use again.”

“I get take-home bottles, but that’s because I’m not using drugs now,” Jerry Otero, a manager at St. Ann’s Corner of Harm Reduction in the Bronx, told Filter. “That would end if I started to use again. Forget the fact that I’m a professional, a responsible dad and stably housed. None of those factors would count.”

“OTPs are a product of prohibition,” he added, “and they can never be compatible with harm reduction or human rights.”

The excessive handwringing around allocating additional take-homes reveals a profound distrust for adults taking methadone without being watched. It’s infantilizing. In no other physician-patient relationship is access to medication subjected to such intense scrutiny and surveillance. When I’m prescribed medication, even an opioid, a multidisciplinary team doesn’t conduct an evaluation to see if I have a job, family responsibilities, use drugs or attend medical appointments regularly.

The handwringing is also about clinics not losing their supposed unique selling point,  if all they do is refill bottles. AATOD’s now-defunct Program not a Pill campaign insisted that “medication-assisted treatment” is more than just medicine. Counseling was an absolute necessity, it held, but there was little discussion of that at the conference.

Retention in treatment was a major focus. Studies show that rates are uneven and decrease substantially over time.  It’s no secret why: The culture of cruelty erects numerous barriers to both entering and staying in treatment.

What took SAMHSA so long? It’s been known for decades that these rigid regulations result in high drop-out rates. 

Several updated SAMHSA regulations can eliminate obstacles if OTPs adopt them. Now, patients can start treatment with 50 mg of methadone or more (it used to be 30), which is more likely to hold people; and split dosing (twice-daily) is allowed without federal approval. Split dosing and the correct dose is particularly important for pregnant patients, as the workshop “The Right Dose Every Day,” led by Dr. Ruth Potee, made clear.

What took SAMHSA so long, especially in the fentanyl era of historic overdose deaths? It’s been known for decades that these rigid regulations result in high drop-out rates. How many people would be alive today if these rules had been in place at the beginning of the overdose crisis?

At the workshop, “Harm Reduction to Increase Patient Engagement and Retention: A Case Study,” Erin Russell, a fierce harm reduction advocate, explained how she trained staff at Behavioral Health Group (BHG) on harm reduction principles and practices.

“I met with the OTP leadership every month and then we did group coaching with the counselors and nurses,” Russell told Filter. “What really made the difference was creating space for people to talk about their hang-ups with harm reduction.”

Apparently the coaching worked. The retention rate at these BHG clinics increased by 15 percent from 2024-2025 according to Tiara Reddick, regional director of operations. Using harm reduction not only boosts retention but increases profit margins, and this is what OTP owners want. Russell said, “Retention rates are an important business metric.”

Her last slide took me by surprise:

What would Dr. Patt Denning—the harm reduction pioneer and co-author of Over the Influence: The Harm Reduction Guide to Controlling Your Drug and Alcohol Use—think of this whole approach? I asked her.

“It’s always tempting to take whatever improvements you can get, so of course, let’s try to get harm reduction into methadone clinics. But it’s not going to work. The system itself is antithetical to harm reduction, which is about flexibility and choice. The way the methadone clinic system was designed doesn’t allow those two things,” Denning told Filter. “And clinics can’t practice radical neutrality because there are so many rules that patients have to follow or they won’t get their medication.”

This year, there was no DEA agent on the opening or closing plenary of AATOD’s conference, as there usually is. It was time to downplay the drug warriors’ central involvement in methadone clinics—not a good fit with talk of patient-centered care and the principles of harm reduction. Instead, the DEA sent two agents to speak at the AATOD open board meeting. The field of opioid treatment may be evolving, but the DEA is not.

At the closing plenary there was the customary raffle and one of the winners walked away with a portable bluetooth speaker. Then Mark Parrino, AATOD’s forever-president, rose to address the half-empty ballroom. He shared a story about a menacing squirrel who became dependent on methadone. Every day, the rodent ripped open trash bags full of discarded plastic bottles and swallowed the leftover drops of cherry colored liquid.

Parrino explained how the staff tapered it off methadone. If his squirrel story was related to “the evolving field of opioid treatment,” it was lost on me. 

Photographs by Helen Redmond

Helen Redmond’s book, Liquid Handcuffs: Policing and Punishment in Methadone Clinics and the Future of Opioid Addiction Treatment, will be published by North Atlantic Books in March 2026. It is available for pre-order here. 

The post Are Methadone Clinics Really “Evolving” Toward Harm Reduction? appeared first on Filter.

In the corner just behind a tall, iron gate, a group of patients gathered. In the center, an old woman lay on the pebbled ground, talking loudly in a scratchy voice between drags from her cigarette. A man wearing stained jeans and holding an extra-large Circle K cup stood beside a younger woman in flannel pajamas, and chunky black slides. The officer had also noticed this congregation and was walking toward them; according to a posted sign, no loitering was allowed on the premises. I guided my bicycle to the rack behind them, a little worried whether it would still be there when I returned. 

It was January 2020, and I was applying to work part-time as a physician at a methadone clinic. Primarily an emergency room doctor, I had become increasingly interested in addiction medicine over the past few years. 

To gain credibility—something I was always chasing as a young woman in medicine—I decided to pursue board certification in the field. This meant that I needed to work at least 500 clinical hours in addiction, and in Tucson, the only place looking for help was a methadone clinic. I had never imagined myself working somewhere like this; methadone clinics weren’t exactly seen as desirable. Nobody in my medical school aspired to work at one, nor was it presented as a career goal that we might strive for. But here I was, in a nice dress and leather boots, with freshly washed hair, ready for my interview. 

If my doctor asked me to follow such condescending, punitive rules, I would be outraged. But if you wanted methadone, there was no choice but to comply.

Swinging open the tinted glass door, I entered the buzz of the crowded waiting room. A line of patience formed to my right, waiting to get their daily doses. The air smelled of stale cigarettes and cherry cough syrup, the flavor added to the liquid methadone. Many of the patients had sunburned shoulders, and a few had cheap, thin roller bags that they dragged alongside them—signs of housing insecurity. 

To my left was a sea of vinyl chairs filled with patients, waiting to see therapists, clinicians, or lab techs. Several times a year, patients were randomly selected to give a urine sample to determine whether they were still using drugs. They peed into cups held over toilets with silver handles taped in place to remind them of the rules, which were printed on a piece of paper, highlighted in yellow, and tacked to the rear wall—no flushing the toilet or running the faucet, even though there was no sink inside the small bathroom itself. There was no lock on the door. The freshness of the sample was verified by a flimsy thermometer attached to the cup. 

The printed rules also detailed what happened if someone couldn’t pee within three minutes: If they decided to leave the clinic instead of waiting in the lobby and trying again, a staff member would watch them urinate when they next returned.  

If my doctor asked me to follow such condescending, punitive rules, I would be outraged. I would demand to see their policies, argue with the staff, or storm out. But if you wanted methadone, there was no choice but to comply. 

…

[The previous year, the author had received a shocking letter about her Suboxone (buprenorphine) prescribing.]

Much like text messages from my mom, the letterhead was in all caps, and the sender was none other than Michigan’s Medical Board. It was definitely not an award. 

“Dear Licensee,” it began. “Enclosed is an Administrative Complaint, charging you with violation of the Public Health Code. You must respond to this Complaint IN WRITING WITHIN 30 DAYS from the day you received it. If you fail to do so, the complaint will be sent to your Board’s Disciplinary Subcommittee to impose a sanction…” 

I flipped to the next page, and there, to the bottom of the page, I found my first clue: “Suboxone is known as ‘prison heroin,’ and is commonly abused and diverted.”

Prison heroin? Really? Suboxone was increasingly seen as a gold-standard treatment for opioid use disorder; it was not some fringe illicit drug. The letter read less like one from an official medical board, which was supposed to be based in science, and more like propaganda from some abstinence- based troll on social media. Yet here it was. 

“From May 2018 through September 2018, Respondent wrote seventeen (17) prescriptions for controlled substances in Michigan … Respondent’s conduct constitutes a violation of general duty, consisting of negligence, or failure to exercise due care, and fails to conform to minimal standards of acceptable, prevailing practice for the health profession…”

The legal jargon was confusing. What had I done wrong? What was at stake? Would I lose my medical license? The last four years of medical school, three years of residency, and one year of fellowship all made obsolete? How would I repay my $262,000 of student debt? 

The board was continuing the century-long tradition of criminalizing maintenance medications and the doctors who prescribed them. Via telemedicine, I was making buprenorphine too accessible. 

In 1981, [drug historian] David Courtwright asked [methadone pioneer Dr. Marie Nyswander], “Which groups would you identify as the most influential opponent of methadone maintenance?” 

She answered, “My feeling was always that the [Federal Bureau of Narcotics] that turned the doctors against addicts, that scared them out of treatment… As far as I like to think of it, the Narcotics men had really so scared the doctors that they abandoned the treatment of drug addiction, and therefore, there is no place for them to go. So they would be against addicts in the sense that professionally, they are denying a group of people treatment. “

Once I knew this history, I began to see the Michigan Medical Board investigation in a new context. The board was simply continuing the century-long tradition of criminalizing maintenance medications and the doctors who prescribed them. Even though addiction docs such as myself were reducing the demand for illegal opioids, enforcement saw our contribution to the opioid supply as the greater offense. Via telemedicine, I was making buprenorphine too accessible. 

Although changes in federal regulation meant that agents could no longer straight-out arrest doctors like me who prescribed medications for opioid use disorder, they could still get us when we broke small technicalities, an error easy to make in today’s confusing, regulatory patchwork. 

Such an approach framed a systemic problem—stigma against addiction treatment—as an individual failing: a doctor who is too loose with her prescription pad, that is, a modern-day script doctor. The goal? To scare doctors away from offering addiction treatment. They had also tried this with Marie. And, by and large, it worked. 

I emailed the president of the Michigan chapter of the American Society of Addiction Medicine (ASAM). Myself a member, I assumed they would be outraged that the medical board referred to buprenorphine as “prison heroin.” Who knew how many other doctors have been accused of the same thing? Once ASAM heard of this, surely they would start advocating to change the medical board’s opinion. 

Instead, the president emailed me back to recuse herself from discussing my situation, as she herself was on the Michigan Medical Board. Were addiction doctors themselves leading the charge against me? 

Later, I’d learned that Marie and [methadone pioneer Dr. Vincent Dole] felt the same betrayal, and were outraged by the medical community’s silence when regulators circumscribed their ability to offer effective treatment. A cruel loneliness settled into my bones; there was nobody to help shoulder the repercussions or to help guide me through this experience. If only I had a mentor, someone to help me forge this path through the wilderness. But, like Marie, I was doing this alone.

Excerpted from Chapters 1 and 3 of Mother of Methadone: A Doctor’s Quest, a Forgotten History, and a Modern-Day Crisis by Melody Glenn (Beacon Press, 2025). Reprinted with permission from Beacon Press.

You can read Filter‘s interview with Dr. Melody Glenn here.

Top image by Helen Redmond

The post A Doctor’s First Taste of the Methadone Clinic  appeared first on Filter.

In Mother of Methadone, the author invites readers into Nyswander’s personal and professional life and details the many barriers she faced during her career. Glenn tells the little-known history of how the Federal Bureau of Narcotics, the forerunner of the Drug Enforcement Administration, drove doctors out of addiction treatment with threats and imprisonment. These “narcotic agents” harassed and threatened Nyswander while she was researching methadone at Rockefeller University. She didn’t back down.

Glenn was looking for a woman mentor and found one in Nyswander. She weaves her story of becoming a certified addiction doctor with key moments in Nyswander’s life. As an emergency department physician, she treated numerous patients with opioid use disorder (OUD) and found it extremely frustrating. They never seemed to get well, and Glenn ended up “blaming the victim.” She admits to accepting many of the stigmatizing ideas about people who use drugs, and it bothered her.

Glenn’s journey to become certified involved many of the same obstacles Nyswander confronted decades earlier. How much have things really changed?

When she discovered the work of Nyswander, who had a tremendous amount of respect and empathy for drug users, it was a lightbulb moment. And there was a highly effective and safe OUD medication, methadone, that cut the rate of overdose deaths by over half.  Glenn also learned about buprenorphine. In the book there is a powerful passage where she gives a very sick patient buprenorphine, and a few hours later he’s feeling great and wants to leave the hospital. Glenn is elated.

Glenn’s journey to become certified in addiction medicine involved many of the same obstacles Nyswander confronted decades earlier. This makes Glenn wonder, How much have things really changed?

For two years she worked in an opioid treatment program (OTP, or methadone clinic), and witnessed how methadone changed her patients’ lives for the better. But at the same time the culture of cruelty made it difficult for them to stay in treatment. In the emergency department (ED), Glenn worked to create a modern addiction service that welcomes people who use drugs and offers OUD medication.

The book describes how she waits for hospital management to approve a press release promoting their upgraded addiction services. They never do. Glenn receives an email, “…are other ED’s in town doing this or are our teams the only ones. If so, does EMS [emergency medical services] know we are providing the service – will they bring all suspected OD/addiction patients to us because of the service? There is concern that if we announce this publicly we will become the city’s primary resource for substance abuse.”

Like that would be a bad thing! Glenn was furious.

This medical NIMBYism operates throughout the United States health care system. Hospitals love to promote their expertise in every field from liver transplant to sports medicine, but addiction? Not so much. It’s pure discrimination.

“I had to keep one foot planted in the grass roots of harm reduction, listening to users’ priorities and paying attention to their solutions.”

The final chapter of Glenn’s journey, perhaps the most important, involves her becoming a harm reductionist. In Tucson, she hooks up with Sonoran Prevention Works, and risking arrest, hands out sterile syringes and other harm reduction supplies.

“With the help of harm reduction, I would grow more comfortable walking the narrow line between working from within the system and from outside it,” she writes. “I did not want to squander my opportunity to advocate from within the house of medicine, as my professional credentials gave me access and credibility in a way that many people who use drugs did not have. But, to appropriately steer my actions, I had to keep one foot planted in the grass roots of harm reduction, listening to users’ priorities and paying attention to their solutions.”

Mother of Methadone should be read by physicians and other health care providers if they, like the author and Dr. Marie Nyswander, aim to practice addiction medicine with empathy and humanity. Filter’s interview with Dr. Melody Glenn has been edited for length and clarity.

Helen Redmond: How did you get interested in methadone and Dr. Marie Nyswander? 

Melody Glenn: In 2020 when I went to interview for a position as a physician at the methadone clinic, I realized I had some stigma about methadone, and I felt that it wasn’t just me; there was probably a whole cultural stigma against the medication in our society.

What’s the history of this? Has methadone always been stigmatized ever since its origins? So I went to the archives. I started looking in the New York Times Time Machine, in databases for old newspapers and medical journals. The stigma has been there since the beginning. Then I ran across an article in the Journal of the American Medical Association marking the 40th anniversary of methadone maintenance treatment. There was a picture of Dr. Nyswander and Dr. Vincent Dole, and the way it described her just really drew me in. She was very charismatic and charming and rebellious, and defied mainstream medicine to push addiction medicine forward.

Some people claim that methadone maintenance is just as influential and remarkable as the discovery of antibiotics, which I think is accurate. Overdose kills so many people every year, and here we have a very effective treatment—it’s just underutilized. Instead of opioid maintenance, treatments are abstinence-based and predicated on the idea that addiction is a moral failure or maybe even evidence of psychopathy. Nyswander and Dole believed that addiction was a medical disease for which they had a successful treatment. For a few years methadone rode this wave of success, and even though there was stigma there was also a lot of support, more support than I would say it has now. Nyswander had articles about her published in the New Yorker and then Vogue, and that’s just not something you see very often. 

“The founder of methadone maintenance hated the regulatory clinic system. So why don’t we listen to her?”

 

HR: How has Nyswander impacted your work as a physician? 

MG: She’s become a mentor. Despite the fact that almost a century spans between our careers, we share a lot of similarities. Neither one of us learned much of anything about addiction during our medical training, had many female mentors or intended to become an addiction physician, and we fell in love with methadone. We both found addiction medicine as a way to practice social justice and faced persecution from regulatory authorities because of it. We often felt like we were fighting the entire establishment all by ourselves.

So it just felt so rewarding and encouraging to see that someone else had been through this and thrived. Whenever I feel like I’m swimming upstream, I think of all that Nyswander went through and all she accomplished. She could very easily have given up, but didn’t, and the world is better because of it. Dr. Nyswander also helped me envision a world beyond methadone clinics. The founder of methadone maintenance hated the regulatory clinic system. She thought that any doctor should be able to prescribe it from any kind of clinic. So why don’t we listen to her?

HR: You mention the doctor-as-savior trope in the book. Can you unpack that?  

MG: I’m definitely trying to avoid it but it’s hard. If you yourself are not doing that, everyone else wants to put you into that role. When you look at medical stories, it’s so common to find ones in which the doctor comes in and saves the day. A community was lost until some visionary doctor appeared and guided them to become the hero. The doctor is effectively stripping the patients and communities of their agency.

It’s an inaccurate narrative because nobody works in isolation, and nobody’s success is solely attributable to their own hard work. I think it’s morally wrong. I believe the doctor’s role should be to listen, amplify and support the community in which they are working, offering some technical assistance along the way.  How can you make the world a better place without falling into the Savior role? Writing this book was a way for me to envision a different path forward, trying to really write the anti-savior narrative. In the end, harm reduction really provided those answers. Working with a group of people, you’re part of a team and they have expertise too. 

“The majority hate the overly strict rules, the carceral environment that effectively turns methadone maintenance into a form of chemical handcuffs.”

HR: In the book you document that Nyswander was a critic of the methadone clinic system. Can you outline some of her criticisms—and if you share them, having worked in an OTP? 

MG: I have a quote in the book which I think it’s so perfect, where Nyswander goes on this rant about the methadone clinic. She wants the medication to be delivered in every kind of clinic and hospital, and for any physician to be able to prescribe methadone— obstetrics, surgery—instead of leaving methadone to federally licensed clinics. 

Referring to her stable patients she said, “It’s just absurd for them to be stuck in a methadone clinic. I’ve had patients for 17 years. They’re better rehabilitated than you and I. There has been no drug use for 17 years and there is no reason in the world why they couldn’t have a month supply, six months supply. Many of my patients get four weeks of medication, they travel, no problem. It’s absurd to keep them in the clinics as part of keeping them isolated and keeping the finger pointed on them and reminding them of what unreliable people they are.”

I thought it was so beautiful how she put it. Methadone clinics are carceral, restrictive. Although I do have some patients who enjoy the structure of the methadone clinic, they appreciate the resources that are offered, I would say the majority have the opposite experience, where they hate the overly strict rules, the regulations, the carceral environment that effectively turns methadone maintenance into a form of chemical handcuffs. For the people who like the clinic, they can go, but the other people who are more stable really should have other options.

HR: Why are physicians so reluctant to work with people who use drugs, for example by prescribing buprenorphine? How can that change?

MG: I really think it’s a trifecta of stigma, overregulation and history. The 1914 Harrison act effectively removed addiction treatment from the purview of medicine. Doctors stopped treating patients and thought addiction is not a medical problem, it’s something better handled by incarceration or by behavioral health. Doctors haven’t learned anything about addiction. Medical schools weren’t teaching it and residencies weren’t either.

There’s overregulation. Back when there was the X-waiver, there were so many doctors who didn’t want to get waivered because they thought it must be really difficult and dangerous, and if there’s extra regulation I don’t want to be part of that. Now, more and more medical schools and residencies are teaching doctors how to start buprenorphine and methadone, they’re showing that there is treatment for addiction to opioids that in the past we just saw as really hopeless. But lots of programs are still neglecting to teach the philosophy of harm reduction, of meeting people where they are and supporting any positive change. Until we incorporate the harm reduction component, I think the stigma will remain. I also think medical institutions need to make sure that people who use drugs are at the table. 

“I went out to join harm reduction activists. They’re doing the things that need to be done instead of just pandering to the status quo.”

 

HR: Why were you willing to get arrested for handing out sterile syringes? 

MG: I got to this breaking point. I had a difficult situation with my hospital and the administrators. Despite all the work I had been doing to get doctors and the hospital onboard to improve the services we offer to people who use drugs, I felt like they would never actually care about the humanity of people who use drugs and never really offer what we need to actually get there all the way. I guess it was very slow going—small, incremental changes—and the longer our health care system took to implement change, the more lives would be lost.

I was sort of tired of waiting, so I went out to join some of the harm reduction activists who are taking these steps to make the world better for people who use drugs, even if it’s illegal. They’re doing the work. They’re doing the things that need to be done instead of just pandering to the status quo. I needed to do something that was going to make a difference. I started to work with a harm reduction organization and went out into the field to learn from them. I wasn’t trying to get arrested, and I was hoping that wouldn’t actually happen. I was just feeling so frustrated. It reminded me of the stories that I had heard of the early activists during the HIV/AIDS epidemic where they’re frustrated that the FDA is taking forever to approve antiretrovirals. And I thought of the movie Dallas Buyers Club and they just take it into their own hands.

HR: You got in trouble with the Michigan Medical Board. What happened? 

MG: I was working for this startup in California and living in the Bay Area. One of our nurse practitioners in Michigan had recently resigned and she had a handful of patients, and I refilled their prescriptions because I was worried if I didn’t they might relapse. We had an attorney who said it was fine, no problem. I was able to do telemedicine for these patients even though I had never seen them and I didn’t have a Michigan medical license. 

It was my first time prescribing anything in that state and it was just a bridge prescription. We could have them come to Ann Arbor another time, because lots of patients live very far away in the Upper Peninsula. It’s not easy for them just to drop everything and go to Ann Arbor and see a new provider. I was trying to look in the prescription drug monitoring program in Michigan, and it said you can’t because you don’t have a Michigan controlled substance license. 

“The Michigan Medical Board accused me of prescribing ‘prison heroin’—that’s what they referred to buprenorphine as.”

I didn’t know that I needed this “special license” to prescribe opioids in another state; nor did our attorneys. We quickly called the pharmacies and tried to cancel the prescriptions, but three of them had been filled. Then the attorney reached out to the Michigan Medical Board anonymously, self-reported, and asked is there anything we can do about this? The person at the Board said the fact that you’re self-reporting and you’re so concerned tells us there’s nothing to worry about. We only go after  the people who are really problematic, and so it’s okay. 

And then weeks later, coming up on my due date for my first baby, I get mail from the Michigan Medical Board. They accused me of prescribing “prison heroin”—that’s what they referred to buprenorphine as. I’m just like, what? How is this medical board using this terminology? Buprenorphine is the gold standard of treatment for opioid use disorder. I was absolutely shocked. 

There was a board investigation. It really dragged on and it was a stressful few months with a newborn. My husband and I were trying to buy our first home in Tucson and we couldn’t get the loan for the house until it was resolved. The lenders were like, “Nope, sorry, if you’re going to lose your medical license, we’re not giving you a loan.”

I ended up getting a fine. It’s considered a disciplinary action, so I have to report it on any kind of job I get, or when I renew my medical license. It will always be on my record. I think they did this to me just because they don’t like telemedicine, they found that it can make buprenorphine too accessible. It wasn’t really the three prescriptions.

HR: What are the two things that everyone needs to know about Dr. Marie Nyswander?

MG: Number one she was a badass who pushed addiction medicine forward time and time again, including the development of methadone maintenance, despite all the people and the institutions who tried to stop her. And two, she wanted to liberate methadone.

You can read exclusive excerpts from Mother of Methadone here.

Top image showing detail from the cover of Mother of Methadone: A Doctor’s Quest, a Forgotten History, and a Modern-Day Crisis (2025), featuring Dr. Marie Nyswander, courtesy of Beacon Press

Inset photograph of Dr. Melody Glenn by Helen Redmond

The post “Mother of Methadone”—Trailblazing and Stigma in Addiction Medicine appeared first on Filter.