A new National Methadone Access and Quality Commission has been created by the Foundation for Opioid Response Efforts (FORE). It will be headquartered at Yale University and chaired by Dr. David Fiellin, director of the Yale Program in Addiction Medicine. Its work is funded by a $917,027 grant from FORE.
“We will provide expert guidance and support to policymakers, health care organizations and funders to improve access to methadone,” Fiellin told Filter.
How likely is the commission to make methadone more accessible?
In a January 28 press release following the commission’s first in-person meeting in New York, FORE President Dr. Karen A. Scott said the commission would bring together “diverse experts and voices.” But a look at who was appointed reveals that it’s stacked with methadone clinic operatives and defenders.
Dr. Robert Sherrick is the chief science officer for Community Medical Services, a national opioid treatment program (OTP) chain. Dr. Kenneth Stoller is the director of the Johns Hopkins Broadway Center for Addiction, an OTP in Maryland. Dr. Michelle Lofwall is the medical director of the Robert Straus and First Bridge Clinics in Kentucky. Dr. Malik Burnett is the medical director of several clinics in Maryland and Zachary Talbott is the owner of Talbott Legacy Centers, an OTP in Tennessee. At a Mount Sinai methadone clinic in New York City, Anita Kennedy is employed as a peer engagement specialist.
Notably, among the commission’s “diverse voices,” not a single member advocates for clinic abolitionin favor of pharmacy pickup for all.
Kennedy and Talbott take methadone, and Fiellin said, “It’s important for us to have former or current patients who can speak to their direct experience. Both have been part of the largest patient organization, the National Alliance for Medication Assisted Recovery [NAMA-R].”
When I pointed out that both also have a conflict of interest, Fiellin wasn’t concerned. “They have intimate knowledge and experience in these complicated settings that is important to inform the work of the commission.”
The American Association for the Treatment of Opioid Addiction (AATOD)—a trade group that seeks to preserve clinics’ stranglehold on methadone by blocking meaningful reform—will exert major influence on the commission.
Stoller is a current board member. Talbott is a former member of the Georgia state chapter. He is also the past president of NAMA-R—a position currently occupied by Kennedy. NAMA-R has a collaborative relationship with AATOD, hosting methadone advocacy training at its annual conferences. Sherrick is a regular presenter at the conference, and in 2025 made the case for implementing a few token reforms in order to stave off changes that could end clinics’ monopoly on methadone dispensing. Fiellin, Talbott and Kennedy have also received awards from AATOD. Kennedy did not respond to Filter’s request for comment.
Another member of the commission is a former diversion investigator for the Drug Enforcement Administration (DEA), Denise Curry. She was involved in the negotiation of a national voluntary restriction on retail sales of methadone.
That’s not to say the commission includes no reform advocates who acknowledge certain fundamental problems with the clinic system.
“I’m in favor of fixing the broken aspects of the clinic system. It is broken by regulatory design and by a racialized history of drug policy.”
“We all love methadone. We think it’s a lifesaver,” Beth Meyerson, a professor of nursing and the director of the Harm Reduction Research Lab at the University of Arizona,” told Filter.
“I’m in favor of fixing the broken aspects of the clinic system,” she continued. “It is broken by regulatory design and by a racialized history of drug policy. We know the current system is not working well and we could do better.”
To help the system work better, Meyerson’s university received a 4.5 million grant from the National Institute on Drug Abuse to test an intervention to reduce OTP staff stress and improve patient retention.
But notably, among the commission’s “diverse voices,” not a single member advocates for clinic abolition in favor of pharmacy pickup for all, as with any other medication.
Over the last 50 years, several advisory bodies have examined OTP regulations and offered a series of recommendations. But nothing fundamental has ever changed.
A 1983 review by the Reagan-administration Department of Health and Human Services noted the inflexibility of federal methadone regulations and their failure to keep pace with the “state of the art” in an evolving field. Nothing changed.
In 1995 the Institute of Medicine convened the Committee on Federal Regulation of Methadone.It advocated for reducing strict federal oversight to improve access and moving to a model of “patient-centered care.” The committee, its report stated,“regards the current regulations as unreasonably extensive and intrusive, and finds no compelling medical reason for regulating the therapeutic use of methadone differently from any other Schedule II controlled substance.” But nothing changed.
Zoom up to COVID-19. The pandemic forced clinics to implement emergency measures to keep patients and staff safe from infection. Take-home medication, which is strictly controlled, was suddenly made more available. All patients were screened to receive 14 or 28 days of methadone.This rule relaxation was unprecedented. More take-homes didn’t lead to an increase in diversion or overdose deaths—two reasons often cited for denying them.
The central problem is an implicit consensus that the 50-year-old model of methadone dispensing is still relevant and needed, albeit with tweaks to make it less cruel and dysfunctional.
As a result, space opened up to discuss OTP reform again. In 2022, the National Academies of Sciences, Engineering, and Medicine (NASEM) hosted a webinar, “Methadone Treatment for Opioid Use Disorder: Examining Federal Regulations and Laws.” Over two days, dozens of presenters—from academics and doctors to a DEA administrator and the president of AATOD—discussed longstanding problems in the clinic system.
Policy recommendations were remarkably similar to previous ones: deregulation and “patient-centered” care. But this time, there was direct criticism of clinics’ carceral structure by people with lived experience.
One speaker asserted that clinics are a creation of the drug war. Joy Rucker, former executive director of the Texas Harm Reduction Alliance, was blunt: “Methadone has been used as a social control mechanism throughout the years and that is why we have all these barriers to access. That is what needs to change.”
Several speakers proposed office-based treatment, pharmacy pickup and the integration of opioid use disorder treatment into the medical system. Yet despite these bold proposals to free methadone, no changes occurred.
Following the NASEM webinar, 2023 saw a two-day conference titled “Liberating Methadone: Building a Roadmap & Community for Change,” organized by the National Coalition to Liberate Methadone. The first day focused on research opportunities. Methadone has been studied for decades. There isn’t a need for more research on treatment barriers, which are well documented. The second day was a series of panels that included a representative from the Substance Abuse and Mental Health Services Administration (SAMHSA), the administrative director of a methadone clinic, physicians, lawyers and people who take methadone. But advocates for clinic abolition were not featured on any panels.
The post-conference report’s recommendations included ending the culture of cruelty, promoting a “person-centered approach,” centering lived and living experience, and allowing physicians to prescribe methadone in office-based settings for pharmacy pickup—remarkably similar to what came out of the 2022 NASEM event.
The central problem with these OTP reform advisory bodies is an implicit consensus that the 50-year-old model of methadone dispensing is still relevant and needed, albeit with tweaks to make it less cruel and dysfunctional. They advocate for voluntary, incremental changes that loosen the liquid handcuffs for a few “model methadone patients” but don’t truly threaten the status quo.
Bill Kinkle, a harm reductionist and nurse with lived experience of the harms of the methadone system, is clear-eyed about why. “It does not benefit the gatekeepers of methadone,” he told Filter, “to liberate the one medication that will stop the overdose crisis and bring meaningful and long-lasting freedom from opioid treatment prisons.”
Some members of the new commission at Yale call for maintaining OTP and allowing office-based prescribing. “I don’t think it’s an either-or,” Meyerson said. “I’m in favor of normalizing methadone access, which involves system evolution so that any prescriber can manage their patients on the medication. But I’m also in favor of clinics that will fill the gap. We really need to think about how the system evolves and that there is a safety net, so there aren’t people living in an area with no provider who will treat them and no clinic.”
This position, while promising a better future for some patients with access to office-based prescribing, leaves the structurally racist, carceral clinic system intact.
How can anyone believe that the creators and beneficiaries of the carceral methadone clinic system can be the ones to fix it?
It’s also a nonstarter for any commission dominated by OTP operatives and AATOD members. Why would they ever voluntarily give up their profitable, cartel-like control of the methadone market? For the methadone mafia, real reform equals extinction, and they will fight that through well-funded lobbying campaigns and their longstanding relationships with the DEA and SAMHSA.
Fierce AATOD opposition to the Modernizing Opioid Treatment Access Act is a recent example—unrelenting and full of fearmongering lies. The bill, which was seriously flawed as it only allowed non-clinic prescribing by a small group of addiction medicine specialists, never went anywhere.
“We want to facilitate substantive change, and especially given the unique role that methadone can play in an environment where almost everybody with opioid use disorder is using fentanyl,” Fiellin said. “We recognize that the previous restrictions don’t meet the current public health needs.”
Fiellin’s comment doesn’t promise real accountability for countless fentanyl-involved overdose deaths facilitated by a system that excludes and punishes.
It’s criminal that clinics’ restrictive regulations have still not been eliminated after successive waves of the opioid-involved overdose crisis. This epic failure to save lives means that the DEA, SAMHSA, AATOD and the OTP owners that have fought against change have blood on their hands.
How can anyone believe that the creators and beneficiaries of the carceral methadone clinic system can be the ones to fix it?
Photograph (cropped) of commission members courtesy of FORE