A short holiday post today. Reading my newsfeed I came across an article by Jason Kletter, President of BayMark Health Services, complaining about Section 4 of the proposed Opioid Treatment Act that would allow pharmacies to dispense methadone for the treatment of opioid use disorders.
At present, no opioid, including methadone,can be legally dispensed directly to patients by pharmacies to treat opioid used disorders except for certain buprenorphine medications. Methadone is dispensed by methadone programs, or as their owners refer to as ‘methadone-assisted treatment programs.’
I’ve written about my experiences with corporate methadone in earlier posts. And I agree with Kletter to some extent, that allowing more physicians to prescribe methadone from area pharmacies would be a mistake. Methadone is a complicated substance, with unpredictable metabolism and significant side effects, including significant sedation in many patients.
But I laughed to myself as I read Kletter’s description of the value of ‘behavioral counseling’ and treatment through ‘highly structured opioid treatment programs’ like those that dispense methadone. I agree that behavioral counseling is valuable when a patient establishes a relationship with a counselor over months of hour-long visits. I don’t know the value of requiring 15-minute ‘check-ins’ every week or two in order to maintain one’s take-home doses. I know that many patients go through a revolving door of counselors– changing every few months, and having no say in who they see. That’s a far cry from carefully choosing a ‘good fit’ and establishing a therapeutic relationship over time.
Likewise ‘highly structured’? The ‘structure’ of company that purchased our local clinic favors out-of town docs who toe the line and raise doses to the sky. My experience with company structure was learning that thin-skinned management with no medical credentials eliminate anyone who speaks up. Maybe that’s what Kletter meant by ‘highly structured.’
But I had to wonder… what type of physician is Dr. Kletter who has such passion about protecting patients from greater access to methadone? So I looked up his company, BayMark Health Services. It turns out that HE OWNS A BUNCH OF METHADONE PROGRAMS. Funny — he didn’t mention that in his article.