As Overdose Awareness week comes to an end, the overdose crisis does not. In 2022, 1,799 Coloradans died due to an opioid overdose. The overdose epidemic is poised to be especially lethal in 2023 and beyond. The number of fatal fentanyl overdoses in Denver rose 16% in the first six months of 2023. This crisis demands deploying evidence-based medicine, specifically opioid agonist treatment including methadone, to expand treatment for opioid use disorder (OUD) and save lives.

Methadone is a gold standard treatment for opioid use disorder (OUD), decreasing all-cause mortality by more than 50%. Methadone for OUD is only accessible at an opioid treatment program (OTP) commonly referred to as a “methadone clinic.” OTPs are highly regulated by both federal and state licensing bodies. Historically, receiving methadone has come with high barriers to access, often including long wait times to receive an intake, early morning appointments to enroll and enduring a lengthy intake process while actively in withdrawal. Now is the time to change that.

Fortunately, the Opioid and Other Substance Use Disorders Study Committee, led by Rep. Chris deGruy Kennedy and Sen. Kevin Priola, is meeting now to consider how Colorado can meet this challenge. We urge this committee to consider policies to increase the accessibility of methadone throughout our state, especially as it may be the most effective medication available to treat individuals with an OUD using fentanyl. Members of this committee have demonstrated their interest in expanding access to methadone, including touring Community Medical Services, an OTP where Dr. Stephanie Stewart and Dr. Frazer Grant work as addiction physicians.

The Opioid Treatment on Demand (OTD) model is patient-centered care, welcoming walk-in patients whenever the clinic is open. For example, Community Medical Services operates the nation’s only 24-hour methadone clinic in Arizona, starting methadone and other life-saving OUD treatment around the clock for interested patients. Other opportunities to initiate methadone in non-OTP settings – such as in emergency rooms or other locations via the 72-hour exemption – are possible under existing federal regulations. Colorado needs to incentivize clinics to offer treatment-on-demand services and start methadone in non-OTP settings, especially in settings where people who use drugs already access services.

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Local ordinances and regulations have limited the reach of methadone and other addiction treatment services. Often, localities place strict zoning ordinances on OTPs and where they can open and operate. Further, some communities place certificates of need on OTPs blocking them from operating without explicit approval.

In 51 of Colorado’s 64 counties, there is no OTP. OTPs are often concentrated in urbanized areas, leaving vast reaches of the state without their services. While Huerfano, Rio Blanco and Las Animas counties had the most overdoses in the state in 2016, none of these counties have an OTP.

One strategy to expand the reach of OTPs into underserved regions is by establishing mobile units and/or medication units. For example, Community Medical Services is launching mobile methadone units in Wisconsin and Arizona to provide access to methadone to rural and underserved populations. Currently, most OTPs do not offer mobile methadone services or have medication units. Funds from the state’s opioid settlement agreement have been made available to expand mobile units. Investment and expansion into mobile methadone has been endorsed by the National Governor’s Association’s best practices to prevent overdose. Absent federal action deregulating methadone prescribing, we see the expansion of mobile OTP units as essential to save lives, especially in rural Colorado.

We strongly urge the committee to incentivize methadone treatment on demand, remove local and state ordinances that hinder addiction treatment services and expand access to methadone throughout rural Colorado via mobile methadone and medication units.

Stephanie Stewart, MD, MPHS, MRO, FASAM, Hannan Braun, MD, and Frazer Grant, MD, MS are addiction medicine physicians and members of the Public Policy Committee of the Colorado Society of Addiction Medicine.