Testimony for the Virginia House Health and Human Services Committee, Health Subcommittee in Support of VA SB 841, Mobile Opioid Treatment Dispensing Program

Testimony from:

Stacey McKenna, Resident Senior Fellow, Integrated Harm Reduction, R Street Institute

Testimony in Support of VA SB 841: “Opioid treatment programs; dispensing, medications from mobile units”

February 11, 2025

Virginia House Health and Human Services Committee, Behavioral Health Subcommittee

Chairman Hope and members of the committee,

My name is Stacey McKenna, and I am a resident senior fellow in integrated harm reduction at the R Street Institute, a nonprofit, nonpartisan public policy research organization. We engage in policy analysis and outreach to promote free markets and limited, effective government in a variety of policy areas, including opioid harm reduction. This is why we have a strong interest in Senate Bill 841.

Millions of Americans—estimates range from 2.7 million to 7.6 million—including approximately 150,000 Virginians, are currently living with an opioid use disorder (OUD).^[1] Although overdose fatalities in the Commonwealth have been declining for a little over a year, the increasingly unpredictable illicit drug supply continues to make OUD a dangerous, life-threatening condition.^[2] Indeed, roughly 1,300 Virginians lost their lives to an opioid overdose last year.^[3] 

Methadone is an FDA-approved medication that reduces overdose risk and drastically improves the lives of people with OUD. By preventing withdrawal symptoms and cravings, methadone enables patients to reduce or stop using illicit substances and rebuild their lives.^[4] In fact, compared to people with an OUD who are engaged in non-medication treatment, individuals taking methadone are up to four times as likely to stay in treatment.^[5] They are also more likely to quit using illicit substances altogether, and are much less likely to die of a drug overdose.^[6] 

Furthermore, because the illicit market is currently dominated by potent synthetic opioids—which lead to strong dependence and high opioid tolerance—experts recommend methadone as the best of the available medications for the treatment for many patients living with an opioid use disorder.^[7] Nonetheless, only about one in five Americans with an OUD receive methadone treatment.^[8] This is largely due to decades of overregulation that make methadone difficult to access and diminish the associated quality of care.^[9] 

In the United States, methadone for the treatment of OUD is currently available only through a system of “opioid treatment programs” (OTPs). When OTPs are available at all, they often have long wait lists and limited operating hours, and despite relaxed federal guidelines allowing more take-home doses, many OTPs still require patients to travel to the clinic up to six days per week to take their medication in person and under supervision.^[10] 

Studies have found that drive-times to OTPs average roughly 8 minutes one-way in urban areas and 49 minutes in rural areas.^[11] Research that accounts for non-car travel—for example, walking or taking public transportation—estimates much higher travel times to OTPs, averaging about 45 minutes, with 26 percent of people unable to “access an OTP within 180 minutes.”^[12] Drive times of 10 minutes or more are associated with a 33 percent reduction in likelihood a person will complete treatment.^[13] This is troubling as Virginia—a state with an estimated 150,000 residents suffering from OUD—currently has just 51 OTPs, many of which are concentrated in population-dense areas and would thus require a lengthy commute for many possible patients.^[14] 

Research shows that providing methadone via mobile units can help overcome some of these challenges, improving retention in care and increasing access for vulnerable and underserved people with OUD.^[15] As such, state policy should facilitate OTPs implementing mobile methadone units in Virginia. Last year, following federal regulatory changes, Virginia took steps to allow OTPs to operate mobile units.^[16] SB 841 would help the state further improve methadone access within the OTP system by identifying factors that are preventing OTPs from seeking and receiving approval for such units, and setting up a streamlined, efficient process to facilitate adding mobile methadone programs to existing OTPs.

Methadone is one of the best tools we have in the fight against the overdose crisis. By making it easier for OTPs to get approval for and operate mobile methadone dispensing units, SB 841 would improve access to this medication and save lives. Therefore, I strongly urge you to pass SB 841.

Thank you,

Stacey McKenna
Resident Senior Fellow, Integrated Harm Reduction
R Street Institute
smckenna@rstreet.org 

[1] “Opioid Use Disorder,” Centers for Disease Control and Prevention, Aug. 30, 2022. https://www.cdc.gov/dotw/opioid-use-disorder/index.html#:~:text=About 2.7 million people in the United States report suffering from OUD; Olivia Trani, “The opioid epidemic cost Virginians $5 billion in 2021, new data shows,” VCU news, Jan. 17, 2024. https://news.vcu.edu/article/2024/01/the-opioid-epidemic-cost-virginians-5-billion-in-2021-new-data-shows#:~:text=The data from 2021 revealed,overdose every day on average; Noa Krawczyk et al., “Has the treatment gap for opioid use disorder narrowed in the U.S.?: A yearly assessment from 2010 to 2019,” International Journal of Drug Policy 110 (December 2022).  https://www.sciencedirect.com/science/article/pii/S0955395922002031; “Individuals Reporting Past Year Opioid Use Disorder,” Kaiser Family Foundation. https://www.kff.org/other/state-indicator/past-year-opioid-use-disorder/?currentTimeframe=0&sortModel={“colId”:”Location”,”sort”:”asc”}.

[2] “Provisional Drug Overdose Death Counts,” National Center for Health Statistics, Centers for Disease Control and Prevention, Jan. 5, 2025. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm.

[3] Ibid.

[4] “How effective are medications to treat opioid use disorder?” Medications to Treat Opioid Use Disorder Research Report, National Institute on Drug Abuse, December 2021. https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/efficacy-medications-opioid-use-disorder.

[5] Ibid.

[6] Ibid.

[7] “Drug Overdose and Substance Use,” Virginia Department of Health, Dec. 18, 2024. https://www.vdh.virginia.gov/drug-overdose-data; Stacey McKenna, “Drug Use 101: Physical Dependence and Withdrawal,” R Street Institute Explainer, Nov. 6, 2024. https://www.rstreet.org/research/drug-use-101-physical-dependence-and-withdrawal; Lev Facher, “Fentanyl isn’t just causing overdoses. It’s making it harder to start addiction treatment,” STAT, Nov. 16, 2022. https://www.statnews.com/2022/11/16/fentanyl-isnt-just-causing-overdoses-its-making-it-harder-to-start-addiction-treatment.

[8] “Only 1 in 5 U.S. adults with opioid use disorder received medications to treat it in 2021,” National Institute on Drug Abuse, Aug. 7, 2023. https://nida.nih.gov/news-events/news-releases/2023/08/only-1-in-5-us-adults-with-opioid-use-disorder-received-medications-to-treat-it-in-2021.  

[9] Stacey McKenna, “How Red Tape Limits Access to Medications for Opioid Use Disorder,” R Street Institute Explainer, Nov. 7, 2023. https://www.rstreet.org/research/how-red-tape-limits-access-to-medications-for-opioid-use-disorder.

[10] “Methadone Take-Home Flexibilities Extension Guidance,” Substance Abuse and Mental Health Services Administration, Nov. 6, 2024. https://www.samhsa.gov/substance-use/treatment/opioid-treatment-program/methadone-guidance; David Frank et al., “It’s Like ‘Liquid Handcuffs’: The Effects of Take-Home Dosing Policies on Methadone Maintenance Treatment (MMT) Patients’ Lives,” Harm Reduction Journal, 18: 88, (2021). https://doi.org/10.1186/s12954-021-00535-y.

[11] Paul J. Joudrey et al., “Drive Times to Opioid Treatment Programs in Urban and Rural Counties in 5 US States,” JAMA, 322: 13 (Oct. 1, 2019). https://jamanetwork.com/journals/jama/fullarticle/2752051.

[12] Junghwan Kim et al., “Accessibility of Opioid Treatment Programs on Conventional vs Perceived Travel Time Measures,” JAMA Network Open, 7: 2 (Feb. 20, 2024). https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815277.

[13] Abdullah Alibrahim et al., “Disparities in expected driving time to opioid treatment and treatment completion: findings from an exploratory study,” BMC Health Services Research, 22: 478, (2022). https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-07886-7.

[14] Trani. https://news.vcu.edu/article/2024/01/the-opioid-epidemic-cost-virginians-5-billion-in-2021-new-data-shows#:~:text=The data from 2021 revealed,overdose every day on average;

[15] Brian Chan et al., “Mobile methadone medication units: A brief history, scoping review and research opportunity,” Journal of Substance Abuse Treatment, 129 (October 2021). https://www.sciencedirect.com/science/article/pii/S0740547221002099.

[16] Katie Boyle, “Regulations to Allow Mobile Medication-Assisted Treatment Services Open for Public Comment,” The Voice of the Commonwealth’s Counties, Virginia Association of Counties, Oct. 22, 2024. https://www.vaco.org/county-connections/regulations-to-allow-mobile-medication-assisted-treatment-services-open-for-public-comment; “Integration of the Final Federal Rule: Registration Requirements for Narcotic Treatment Programs with Mobile Components into the Licensing Regulations,” Department of Behavioral Health and Developmental Sciences, accessed Feb. 3, 2025. https://townhall.virginia.gov/L/ViewAction.cfm?actionid=6152.