Liberating methadone: Building a roadmap and community for change

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PROJECT SUMMARY/ABSTRACT As we continue to face the worst overdose epidemic in U.S history, urgent policy changes are needed to expand access to evidence-based treatment to prevent overdose deaths. Methadone maintenance treatment (MMT) is highly effective at treating opioid use disorder (OUD) and cuts overdose risk by over 50%. And yet, MMT remains vastly under-utilized in the U.S. Since the 1970s, MMT for OUD in the U.S. can only be accessed via daily dispensing of medication at highly structured Opioid Treatment Programs (OTPs). Rigid regulations governing OTPs have greatly limited their availability, and have made the treatment experience highly burdensome and stigmatizing for patients. For decades, this system has been described as a form of “liquid handcuffs,” which degrades existing patients and deters new patients from engaging in treatment. For the first time in 50 years, we are at a historic moment that could alter the course of MMT delivery in the U.S.: Federal policy changes to alleviate COVID-19 risks, including increased flexibility for take-home methadone doses, instigated discussions about needed MMT reforms, including expanding methadone dispensing to pharmacies. However, to guide such reforms and inform a more equitable and accessible OUD treatment system, there is a need to gather the scientific evidence, clinical expertise, and lived experience of people receiving MMT. To this end, the NYU Grossman School of Medicine aims to host a 1.5-day conference in July of 2023 in NYC titled “Liberating Methadone: Building a roadmap and community for change.” This conference will provide a unique and timely opportunity to bring together key partners - including researchers, clinicians, policy makers and people who use drugs - to discuss the past, present and future of MMT for OUD. This hybrid in-person/virtual conference will stimulate innovative research and build cohesion across multiple groups, setting the stage for more inclusive research collaborations and policy reforms that meet the needs of the people most affected by the overdose crisis. Through research presentations, panel discussions, and policy working groups, conference sessions will: (1) Discuss the first-hand experiences of patients in the current OTP system and the need for a more accessible, equitable and person-centered treatment system; (2) Create opportunities for innovative research and novel collaborations among diverse partners by reviewing the existing evidence and gaps in knowledge regarding the current U.S. MMT system and alternative methadone delivery models; and (3) Draft and disseminate research, practice and policy recommendations to advance reforms needed to expand MMT beyond the OTP system. The conference will support NIDA priority research areas for the application of science to advance policy, foster true community- engaged research by bringing together a wide array of stakeholders from diverse geographies, racial and ethnic backgrounds, and life experiences, and most importantly, promote innovation towards improving access to life-saving and humanizing treatment and care.