BOX 1—

Recommendations for Improving Access to Methadone Maintenance Treatment (MMT)

Problems during COVID-19	SAMHSA COVID-19 MMT relaxations should be extended through the duration of the pandemic, implemented fully by all opioid treatment programs, and made permanent. MMT programs should consistently implement use of social distancing and masks in clinics.
Take-home doses	Federal policy should allow primary care and pharmacy-based prescribing to increase MMT geographic availability. State and federal policies should not require negative drug tests for take-home dosing eligibility. MMT programs should eliminate take-home bottle return requirements. MMT programs should eliminate lock box requirements for take-home dosing. MMT programs should provide morning, afternoon, evening, and weekend dosing hours to accommodate vulnerable patients, including disabled patients and sex workers. MMT programs should consider transportation and disability issues when determining take-home eligibility.
Counseling and treatment plans	Policies and MMT programs should provide voluntary instead of mandatory individual and group counseling MMT programs should adhere to state minimum counseling requirements and not impose more burdensome standards. MMT programs should provide funding and support for voluntary patient-only support groups, including parenting support groups and support groups exclusively designed for current or former sex workers. MMT programs should allow members of the same households and carpools to attend the same counseling groups.
Costs	Policies should prohibit accelerated tapering schedules and financial detox.
Parenting patients	MMT staff should be trained on the limits of mandatory child protective service reporting requirements and the potential negative outcomes of reporting. MMT programs should allow children into the building, provide free child care on site, and support voluntary parent/child integrated treatment programs.
Patients in the sex trades	MMT engagement and retention of sex workers should be a research and policy priority.
Broader recommendations	MMT regulations should be supported by current research. Additional regulations beyond the federal level should not be allowed. Policymakers and MMT programs should give methadone patients a decision-making role in policy and program practice. MMT programs should fast track patients through intake processes, especially more vulnerable patients such as those who are elderly or disabled. Policies should expand and improve transportation assistance. Disabled patients should be consulted on new facility development, and MMT facilities should be disability accessible. MMT programs should implement cultural competency training for all staff in areas including disability, sex worker rights and health issues, family separation, and antiracism. MMT programs should support harm reduction treatment models as fully as abstinence-based models. Programs should individualize treatment and implement patient-centered practices. MMT programs should serve as drug user health hubs, integrating voluntary services such as hepatitis C virus treatment and safe consumption sites. Health hubs should offer health resources and referrals for vulnerable groups (e.g., preexposure and postexposure prophylaxis, hygiene items, obstetrical/gynecological care, and culturally competent mental health treatment).

Note. SAMHSA = Substance Abuse and Mental Health Services Administration.