Why America has not passed a law to treat addiction better
Methadone can help addicts. But many are loth to make it more easily available
Methadone is “the best tool we have" to fight opioid addiction, says Ashish Thakrar, a doctor at the University of Pennsylvania’s school of medicine. Yet many of his patients are unable to get it. At his hospital, Dr Thakrar can administer methadone for pain or for opioid addiction. But as soon as he steps across the street to his outpatient addiction clinic, he complains, he is barred from doing so by federal regulations. Methadone rules are “very, very silly right now", he sighs.
Heroin or fentanyl addicts can take methadone, a weaker opioid that often comes as a liquid, to blunt their cravings and stave off withdrawal symptoms. Studies suggest this reduces the risk of a fatal overdose by 50-80%. But though safer than fentanyl, methadone is not without risk. Users can overdose, and the drug has a street value. So methadone is available only at a few specialised clinics and subject to intense oversight.
Those who are prescribed it to treat addiction must often receive it every day, in person, for years. That can be hard: around 80% of counties don’t have a methadone clinic. Only a fifth of American opioid addicts receive the medication that experts such as Dr Thakrar think they should have.
In recent years the federal government has tried to improve access to methadone. During the pandemic, it became easier for patients to take home up to a month’s supply. In 2022 two senators, Ed Markey of Massachusetts and Kentucky’s Rand Paul, a Democrat and a Republican, proposed another measure: allowing addiction doctors to prescribe methadone without having to go through a clinic.
This would hardly have been revolutionary. There are only a few thousand addiction doctors in America, and 6.1m opioid addicts. Nevertheless the bill died in late 2024. The explanations for this can be divided into the reasonable, the unreasonable and the cynical. Reasonably, many people feared it might have repeated the original sin of the opioid epidemic, allowing the wanton prescription of an addictive drug. Laxer methadone rules did indeed lead to overdoses. But under Markey-Paul, the addiction doctors would have been subject to the same safeguards that have since curbed the once-lavish prescription of opioids.
A less reasonable explanation is that while voters may support preventing overdoses in the abstract, they do not want to come into contact with addicts. The bill would have allowed local pharmacists to dispense methadone, so addicts might be glugging down their daily dose next to someone buying shampoo.
A final obstacle is lobbying. Two-thirds of methadone clinics are run by for-profit companies, and they are keen to protect their often-lucrative monopoly. “If you look up a cartel in the dictionary, it literally talks about what we are doing here," says Donald Norcross, a Democratic congressman from New Jersey, who introduced the bill in the House of Representatives. “One of the questions I get asked is, ‘How come this [bill] didn’t move?’" Mr Norcross says. “Well, they hired the lobbyists."
Mark Parrino, the president of the methadone clinic trade association, begs to differ. He says clinics support greater access to methadone, but “prefer that it’s done in a way that increases safety" (namely, through more methadone clinics). Donald Trump has mentioned the need for better addiction treatment to reduce homelessness. Mr Norcross plans to reintroduce the bill. “Obviously," he has differences with Mr Trump, he says, but he “worked well" with the previous Trump administration on addiction treatment. And a bill to cut red tape and enhance competition might yet appeal to conservatives.
Stay on top of American politics with The US in brief, our daily newsletter with fast analysis of the most important political news, and Checks and Balance, a weekly note from our Lexington columnist that examines the state of American democracy and the issues that matter to voters.
topics
