Research Sheds Light on Office-Based Methadone Treatment for Opioid Use Disorder

UNIVERSITY PARK, Pa. — A recent study co-authored by Brandy Henry, assistant professor of rehabilitation and human services in the Penn State College of Education, sheds light on the complex factors influencing clinician support for expanding office-based methadone treatment (OBM) for opioid use disorder (OUD). Published in Journal of Addiction Medicine, the researchers surveyed over 1,100 clinicians and found that only 28% supported OBM — a model that would make methadone more accessible by allowing it to be prescribed and dispensed in office settings, rather than solely through federally regulated opioid treatment programs.

The study also revealed disparities in support levels based on clinician demographics, practice settings and experience. Black clinicians and those practicing in academic medical centers were significantly more likely to support OBM, while longer experience treating OUD was also linked to greater support.

We spoke with Henry about the study’s key findings, the evolving policy landscape, and how expanding OBM could improve access and outcomes for patients with OUD.

Q: Since your survey was conducted in 2020, how have methadone-related policies evolved in the wake of the pandemic?

Henry: The pandemic really acted as a catalyst. Temporary emergency regulations allowed for more take-home doses and greater flexibility in how methadone was dispensed. Some of these changes have been extended or are being considered for permanent adoption. The shift demonstrated that many of the restrictions around methadone weren’t necessarily grounded in evidence — they were more about institutional inertia and stigma. As a result, policymakers and clinicians alike are starting to think more creatively about expanding access, including OBM.

Q: Do you think the ongoing fentanyl crisis has changed clinician attitudes or policy momentum around office-based methadone?

Henry: Absolutely. The rise of fentanyl has made the overdose crisis even more urgent, and there's growing recognition that our treatment infrastructure needs to be more flexible and patient-centered. OBM is increasingly seen as one way to meet people where they are, especially in rural areas where there are often no opioid treatment programs. While clinician attitudes are still catching up, I think the policy momentum is definitely moving in the right direction.

Q: Your study found that only 28% of surveyed clinicians supported office-based methadone. Were you surprised by this, and what factors might explain the low support?

Henry: The survey was conducted in summer 2020, right at the start of the pandemic. Since then, we've seen major policy shifts, but at that time, the traditional mindset around methadone prescribing was still dominant. Clinicians were thinking about clinical and liability risks, payment structures which didn’t previously reimburse for this sort of care, and their own comfort with a model that hadn't been widely implemented before. Only a small portion of clinicians — those with larger caseloads, more experience, or working in academic centers — were more open to adopting OBM. This makes sense since these would be clinicians with more knowledge and support to manage the challenges in shifting to a different treatment model.

Q: The study indicates that Black clinicians were more likely to support OBM than white clinicians. What might be contributing to this difference?

Henry: That was a surprising finding. Our best guess is that Black clinicians might be more aware of the inequities in how methadone is prescribed — Black patients are more likely to be steered toward methadone rather than buprenorphine, and the way methadone is delivered can feel more criminalized and restrictive. Black providers may be more sensitive to these dynamics and more open to reforming how methadone is made available. But more research is definitely needed to fully understand this.

Q: Clinicians with more than 15 years of MOUD experience were more likely to support OBM. Does this reflect confidence in the treatment itself or a deeper understanding of the system’s limitations?

Henry: I think it's more about familiarity. They've seen the limitations of the current system firsthand. In some ways, longer-practicing clinicians might also be less up-to-date on newer models, but in this case, their comfort with methadone as a treatment likely made them more supportive of expanding its delivery.

Q: Clinicians working in academic medical centers were also more supportive. How does the culture of these institutions influence attitudes toward OBM?

Henry: Academic centers often have more resources — legal departments, research support and faculty actively engaged in studying these issues. That environment fosters innovation and supports providers who are willing to try new approaches. I think there's potential to learn from these centers and find ways to support smaller clinics in adopting similar practices.

Q: What do you see as the biggest barriers to expanding OBM, and how can they be addressed?

Henry: A major barrier was the X waiver, which required extra training for prescribers. That’s been eliminated now, which is a big win. But beyond that, there's still a lot of misunderstanding about policies and fear of liability. Unlike other medications for opioid use disorder, people can overdose on Methadone, so there is a concern about how to manage that risk. Although, Methadone has historically been dispensed in pharmacies for pain management, which highlights the feasibility of using pharmacies to dispense Methadone for OUD as well. We need better ways for clinicians to connect, share knowledge and learn from each other to keep practice evolving.

Q: What do you see as the biggest barriers to expanding OBM, and how can they be addressed?

Henry: A major barrier was the X waiver, which required extra training for prescribers. That’s been eliminated now, which is a big win. But beyond that, there's still a lot of misunderstanding about policies and fear of liability. Unlike other medications for opioid use disorder, people can overdose on Methadone, so there is a concern about how to manage that risk. Although, Methadone has historically been dispensed in pharmacies for pain management, which highlights the feasibility of using pharmacies to dispense Methadone for OUD as well. We need better ways for clinicians to connect, share knowledge and learn from each other to keep practice evolving.

Q: Given the rapid policy shifts during the pandemic, what lessons should inform future methadone policy?

Henry: The pandemic showed that when there's urgency, policies can change quickly, and clinicians will adapt. Concerns about liability didn’t really materialize, which has given people more confidence. I think we can carry forward the lesson that policies should be informed by both research and the lived experience of clinicians and patients, since in many ways it was innovative clinicians working with patients who paved the way for these changes.

Q: What additional work is needed to expand clinician support for OBM?

Henry: I see two key areas. First, education — getting this information to students early in their careers, whether they’re future doctors, nurse practitioners or physician assistants. Second, continuing education for those already in practice, to make sure they stay current with emerging research and policy.

Q: Finally, how might OBM improve patient outcomes, especially for those facing barriers to traditional treatment programs?

Henry: Methadone has long been the gold standard in managing opioid use disorder, but the way it's delivered has created huge barriers. Opioid treatment programs typically require patients to come in person for daily medications, which is a major time commitment. Office-based models would make treatment more accessible — especially for people who have jobs or live far from clinics. It would also give patients more options alongside other medications like buprenorphine. Ultimately, it's about broadening access to the full spectrum of care.