When I became director of a Methadone Treatment Program in the early 80’s, one of the first things I was told was to get involved with COMPA. It was good advice then and it is more important now than ever.

Methadone treatment was originally introduced in 1964 by Drs. Vincent Dole and Marie Nyswander and has been the gold standard for the treatment of opioid dependency since that time. Today, New York’s methadone treatment system is the largest in the nation, with 109 clinics serving over 40,000 patients. Unfortunately, in spite of 40 years of  research and experience demonstrating methadone’s safety, effectiveness, and cost efficiency, many in society still view dependency as a self-inflicted moral failing rather than a chronic relapsing medical condition which can be successfully treated, and see methadone as simply the substitution of one drug for another.

This lack of understanding of both addiction and methadone has led to the stigmatization of our programs and patients as well as considerable over-regulation. Many of the communities we serve are unaware of our success rates and base their perception of methadone treatment on the few problem patients visible to them. Only 20% of those estimated to need our services actually access and receive treatment. There are only 17 methadone programs located in 9 urban centers  in the entire upstate region, forcing many residents to travel long distances on a daily basis or forgo treatment all together. Research indicates that approximately 85% of those who taper off methadone relapse, yet many people still oppose the use of medication assisted treatment and argue that anything short of complete abstinence is not recovery. Welfare reform, spiraling costs, gentrification of city neighborhoods, a resistance on the part of insurance companies to cover the cost of treatment, and the inadequacy of  New York’s net deficit financing system all further contribute to the challenges facing methadone providers today. Compounding all this, the recent use of methadone for pain management has led to an increase in methadone-related deaths, further fueling misunderstanding and stigma and potentially leading to even more scrutiny and regulation.

In spite of all this I am encouraged by the many initiatives currently underway in New York State. Under the leadership of Commissioner Karen Carpenter-Palumbo, NYS Office of Alcoholism and Substance Abuse Services (OASAS) has moved towards viewing addiction as a chronic disease requiring a person-centered recovery-oriented approach. OASAS, in collaboration with the treatment community has also moved to overhaul the state’s methadone regulations for the first time in over 30 years; develop a model for one outpatient system of care; increase opportunities for staff development; and established the Methadone Transformation Advisory Group (MTAG) process through which we hope to soon be able to offer buprenorphine, provide ambulatory detox, enhance utilization of a phased system of care, increase access in upstate counties with waiting lists by offering interim maintenance, and expand the number of patients on medical maintenance. In addition, NYS recently passed Rockefeller drug reform legislation and OASAS is working closely with New York’s provider associations and the Department of Health to implement the new APG system which will more closely tie reimbursement to the services provided.

Our field is poised on the brink of change and, while the challenges ahead are many and daunting, as I begin my term as President of COMPA, I have a great sense of optimism for the future of our modality and medication-assisted treatment in general. Our programs, with interdisciplinary teams of doctors nurses and counselors and expertise with the use of medications for the treatment of dependency, have tremendous untapped potential for evolving into comprehensive Addiction Recovery Centers. With regulatory relief, a sounder financial footing, and the State’s new direction regarding treatment and recovery, an opportunity to reduce stigma by mainstreaming medication-assisted treatment and provide a more individualized patient-friendly approach to care is within reach. It is now up to all of us to join together, work with our colleagues at the American Association for the Treatment of Opioid Dependency (AATOD) and the Association of Alcohol and Substance Abuse Providers of NYS (ASAP), and engage our staff, patients, their families and their communities to educate and advocate in order to bring these changes to fruition. Please get involved with COMPA, visit our website often, and let’s speak out and tell our story: methadone treatment works; those individuals engaged in such treatment are in recovery; and medication assisted treatment needs to be readily available to all those who could benefit. 

Peter Coleman

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