Addiction treatment advocates turn to an unlikely ally: DOGE

A coalition of advocacy groups including a leading addiction medicine society and a center-right think tank is pressing the Trump administration with an unlikely request: Use the U.S. DOGE Service to make methadone more widely available. 

In a new letter to key Trump officials, the groups argue that the Department of Government Efficiency’s goal of deregulation should embolden federal agencies to relax many of the existing rules that have led patients to dub methadone “liquid handcuffs.” 

Methadone is a common medication that has been used for over a half-century to treat opioid addiction. But it is an opioid itself, and can cause side effects or even overdose, especially when misused. While most addiction medicine experts agree that increased access to methadone could help reduce opioid overdose deaths, the medication remains highly stigmatized and underused. 

In the letter, addressed to Attorney General Pam Bondi and Derek Maltz, the acting head of the Drug Enforcement Administration, the groups argue that current methadone regulations create “an unnecessarily burdensome bureaucracy that harms Americans by restricting patient choices and limiting the autonomy of qualified practitioners in addiction medicine.” 

The letter is signed by the American Society of Addiction Medicine, R Street Institute, National Community Pharmacists Association, American Society of Health-System Pharmacists, and National Commission on Correctional Health Care. 

Methadone is currently only available as an addiction treatment at roughly 2,000 specialized clinics nationwide, many of which historically impose harsh requirements like daily attendance for a single dose, attending often-subpar counseling sessions, and submitting to frequent drug tests as a condition of receiving the medication. 

While a 2024 refresh of those regulations gave methadone clinics the freedom to offer patients more flexibility, states and individual treatment providers can still impose harsher rules if they wish — meaning the changes’ true impact remains unclear. 

The debate surrounding methadone access has swirled for years. The letter from medication advocates represents a new strategy: appealing to DOGE’s anti-bureaucracy ethos. 

In particular, the letter notes that a Trump executive order in February encouraged federal agencies to discard all regulations not based on the “best reading” of the underlying law originally enacted by Congress. 

Limiting methadone to specialized clinics and barring doctors from prescribing it directly, the groups argue, is a regulation, not a law. One report written in 2022 by George Washington University policy researchers argued that the regulations could be rescinded by federal agencies alone, without an act of Congress. 

In recent years, lawmakers from both parties have contemplated allowing physicians to prescribe methadone directly to patients. One bill authored by Sen. Ed Markey (D-Mass.), known as the Modernizing Opioid Treatment Access Act, would allow doctors at methadone clinics as well as those with special addiction certifications to prescribe the medication directly to their patients. 

Despite support from ASAM and other groups, the bill failed to gain traction in the previous Congress. With Republicans now in control of the Senate, the bill is even less likely to move forward. 

The Trump administration hasn’t advanced any meaningful drug policy reforms in its first months, but key officials have indicated support for methadone and buprenorphine, another form of medication-assisted treatment. During his confirmation hearing, Health Secretary Robert F. Kennedy Jr. said he supported the medications’ use, though his answer misleadingly claimed that the medications did not represent the “gold standard” in treating opioid addiction (he advocated instead for 12-step recovery programs like Alcoholics Anonymous). 

In a recent CNN interview, Maltz, the acting DEA Administrator, said the agency “recognizes the importance of these opioid use disorder drugs, and we’re going to continue to make sure they’re readily available to all Americans that need them.” 

The advocacy groups’ letter closed with another Trump-minded appeal, arguing that deregulating methadone could help reduce demand for illicit opioids and, in doing so, help reduce drug trafficking and trans-border crime. 

“In short,” the letter reads, “please equip qualified practitioners with the tools they need to fight the drug cartels, too.”