Safer Solutions: Extreme Weather Events Highlight Market Failures in Methadone Access
When snowstorms, hurricanes, wildfires, and other extreme weather events make travel dangerous or impossible, people who take prescription medications typically have a supply at home to tide them over until conditions normalize. But that’s not always the case for people who take methadone to treat opioid addiction, due to overregulation by the federal government that is unique to this medication. Under current federal and state regulations, many people who take methadone to treat opioid addiction must travel to a specialty clinic daily to take their medication and are not allowed to have any (or more than a few) doses at home. When a disruptive event suddenly cuts off access to the clinic, it can set back people’s recovery journeys and could even mean the difference between life and death.
An Already Inflexible System
The American methadone access system is highly inflexible and uncompetitive—a situation that can negatively impact access, patient care, overdose prevention, and recovery even in good weather. Methadone, a highly effective, “gold standard” treatment for opioid use disorder, is the only Food and Drug Administration-approved medicine in the United States that cannot be prescribed by a doctor and dispensed by a pharmacy for use at home. It can only be obtained via one channel: opioid treatment programs (OTPs), colloquially known as methadone clinics. Prescription opioids themselves—drugs like oxycodone or morphine—are not subject to this heightened regulatory structure, nor is methadone prescribed for pain. This structure means that many patients must travel to an OTP every day for their methadone dose, while some might qualify for a few days or weeks of “take-home” doses to extend the time between clinic visits.
The current system makes methadone access tenuous on a good day. Many people live far from the nearest OTP. Long commutes and short clinic hours result in fewer people taking methadone, more people missing doses, and more people leaving treatment (and possibly returning to the dangerous illicit drug market). On top of these everyday barriers, extreme weather exacerbates the inflexibility of our system for accessing this lifesaving and life-changing medication.
Weathering the Weather
Rep. Donald Norcross (D-N.J.), co-author of the Modernizing Opioid Treatment Access Act, told a story about a snowstorm in his hometown of Camden. Through his apartment window, he could see footprints in the deep snow leading from the subway station to a nearby OTP. These people braved dangerous conditions because they had no choice; however, not everyone who takes methadone for opioid addiction can get their medication in such extreme conditions.
When Winter Storm Uri hit Texas in 2021, many clinics closed due to loss of power and water. Some patients were able to get “guest dosing” from clinics that remained open, while others went to emergency rooms. Unfortunately, some hospitals did not have enough methadone on hand to meet the sudden demand, and as a result, a number of patients “were unable to obtain methadone and began to experience withdrawal, which profoundly increases the risk for [a return to using illicit drugs] and overdose.”
OTPs do occasionally announce closures ahead of extreme weather. In these situations, they can provide advance take-home doses to get patients through the closure. But when an OTP stays open during a storm, the clinic does not provide weather-related take-homes to patients who do not already have take-home dose privileges. People without take-homes are expected to travel in dangerous conditions to maintain their daily treatment. One OTP medical director described a time when, facing a two-inch snow forecast, the clinic decided not to close and therefore did not issue weather-related take- homes. When the storm unexpectedly delivered eight inches of snow, some patients could not get to the clinic and missed their dose. The doctor said the program failed its patients in this instance.
The irony is that because methadone is so tightly regulated, it can be easier to access illicit opioids than it is to access methadone—including during an extreme weather event. As one member of a Reddit forum about methadone noted, “I guess [the OTPs that stay open during a severe storm] figure that people found a way to get high in bad weather and they should have the same energy to get to the clinic, but they don’t realize that it’s not the same thing. My dealer would come to me if I had no car, the clinic is not going to do that.”
Doing Better—Rain, Snow, or Shine
Many of these weather-related issues are a natural extension of the regulation that places methadone access for opioid addiction exclusively with OTPs. Whether it’s snow or car trouble, a hurricane or a sudden illness, wildfires or a rural address hours from the nearest clinic, the OTP-only system creates barriers to access that can mean the difference between stability and a return to drug use—and even between life and death. But a fresh look at how we treat opioid addiction can help transform this situation. We can improve access in good and bad weather alike by encouraging a diverse market for methadone treatment and by putting patient access over regulation that keeps too many people away from life-changing care.