Another call for office‐based methadone

Brendan Saloner, Ph.D., in a Viewpoint (“Office‐Based Methadone Treatment — Has the Moment Arrived?”) published online November 4 in JAMA Psychiatry , argues not for eliminating opioid treatment programs (OTPs), but for changing them. As for the question mark in his article's title, the text of the Viewpoint provides the answer: Yes. Saloner, at Brown University, advocates in favor of the Modernizing Opioid Treatment Access Act (MOTAA), reintroduced many times (most recently in June) in Congress. Some, especially the American Association for the Treatment of Opioid Dependence, claim MOTAA would eviscerate OTPs by allowing office‐based methadone prescribing for opioid use disorder (OUD). Concerns include cherry picking, physicians unfamiliar with methadone pharmacology, and manner of dispensing, to name a few. Saloner told ADAW last week he is not in favor of eliminating OTPs. In fact, the Viewpoint stated that if MOTAA does pass, it would not have a big effect. Few patients and few physicians would take advantage of it. What Saloner does want is some change in the current system, which he wrote has “ossified regulations.” There have been massive changes, as the regulations were dramatically updated in 2024 (see ADAW https://onlinelibrary.wiley.com/doi/10.1002/adaw.34023 ), a fact OTP detractors and MOTAA proponents rarely acknowledge.