Federal data shows most people who need treatment for opioid use disorder don’t get it. Yet nearly every state has laws that limit access to opioid treatment programs, according to a new report from the Pew Charitable Trusts.
Researchers say these state restrictions go against evidence-based practices and limit access to care.
Opioid treatment programs are facilities that can offer all three U.S. Food and Drug Administration-approved medications for treating opioid use disorder: methadone, buprenorphine and naltrexone. Methadone, specifically, can only be offered at opioid treatment programs, while the others can be prescribed by doctors like other medications.
Pew researchers found that 19 states — including the Midwest states of Indiana and Missouri — and the District of Columbia require facilities to present a legal document known as a certificate of need showing the services are necessary before opening a new treatment program. Indiana also limits the number of treatment programs that can open.
Missouri, Indiana and Ohio have additional zoning laws that go beyond regulations for other medical facilities, limiting where an opioid treatment program can open. Federal law requires patients in these programs to be screened for drug use, and Indiana, Ohio and Kentucky also have laws requiring observation during urine sample collection, which can be uncomfortable for clients.
Kentucky and Ohio also require more than the federally recommended eight annual urine screenings. Twenty-six states require more than eight screenings, and researchers say this can raise the cost of treatment.
In every state except South Dakota and Massachusetts, programs can force people to leave treatment if they use substances, even though federal guidelines and research supports continued treatment in lieu of a sudden stop to treatment in instances of continued drug use.
While the American Society of Addiction Medicine's guidelines for treating opioid use disorder say that “There is no recommended time limit for pharmacological treatment with methadone,” eight states, including Missouri, Indiana and Kentucky, have rules that make discontinuation of medicine the goal of treatment. According to Pew researchers, these rules may encourage providers and patients to stop treatment when it is still needed, and potentially increase the risk of overdose death.
Requiring government identification can also be a barrier in accessing treatment for some. Illinois and Indiana are among eight states that require government ID, which can be a challenge for some, including undocumented immigrants, people who have been incarcerated and those experiencing homelessness.
Research shows that medication for opioid use disorder can be effective without counseling, and that strict counseling requirements can reduce treatment retention. Yet 23 states require a set counseling schedule to stay in treatment that can affect a patient’s ability to take home medication. Indiana, Kentucky, Ohio and Missouri have some form of set counseling.
Other barriers include location of clinics rules regarding take-home medication eligibility and hours of operation. In 41 states, opioid treatment programs are not required to operate outside of regular business hours, 8 a.m. to 5 p.m.
Researchers say these restrictions limit access to care when opioid use continues to be the leading cause of drug overdoses. According to 2020 data from the U.S. Centers for Disease Control and Prevention, 75 percent of the almost 92,000 overdose deaths involved an opioid.