BOSTON — Opioid addicts seeking medication-assisted treatment face myriad barriers in Massachusetts, according to a new report, which calls for more resources and changes in policy to improve access to the programs.

The report is the work of an 18-member commission that looked at access to programs that use three federally approved anti-addiction medications — methadone, buprenorphine and naltrexone — to help addicts get clean.

It found numerous barriers to treatment, ranging from a lack of providers and onerous regulations, to local opposition to treatment facilities and reluctance among physicians to treat opioid addicts.

The commission is comprised of state officials, lawmakers, physicians and substance abuse experts.

"There's still a lot of stigma out there, in the community as well as the medical field," said Dr. Norma Lopez, an addiction specialist at the North Shore Physicians Group in Lynn. "We need to do a better job explaining that this is not a moral failing, it's a chronic condition that requires medical treatment, no different than diabetes or hypertension."

There is limited access to methadone statewide, the report noted, in part because of strict federal regulations for dispensing the controlled substance to patients.

Specifically, the North of Boston region lacks access to naltrexone programs with only a half-dozen licensed providers scattered around the region, the report noted.

And lack of access to facilities that offer the medication-assisted programs, with many clustered around the metro Boston area, means many patients can't get into treatment.

The report's authors made a litany of recommendations, such as advocating for changes in federal and state laws to allow more access to the programs, expanding training for physicians and medical workers to administer the medicines, and working with local governments to allow more medication-assisted treatment facilities to open.

In 2018, more than 2,000 people died of opioid overdoses in Massachusetts, according to the state Department of Public Health. Most of the deaths involved fentanyl.

Treatment options

There are three types of medication-assisted treatment in use around the state, to varying degrees.

Methadone, which is usually dispensed to addicts who visit clinics for a daily dose, has been used for decades to treat heroin addiction. Until recently, it was one of the only options for medication-assisted therapy. The medication, which acts to block opioid receptors in the brain, can ease withdrawal symptoms that may trigger a relapse.

There's buprenorphine, which is sold by its brand name Suboxone and typically prescribed by a doctor, which has become a preferred treatment.

Neither come cheap. While methadone treatments can cost up to $3,500 a year per patient, even the generic form of Suboxone costs two to three times as much, according to the National Association of State Alcohol and Drug Abuse Directors.

And there's naltrexone, a non-narcotic drug often known by its brand name Vivitrol, which is injected monthly. But the drug's hefty price — about $1,300 per shot — also puts it out of reach of some addicts.

The commission's report recommends expanding the use of medication-assisted treatment in the state's jails, where addiction rates are high, to help inmates safely detox and stay clean both behind bars and after release.

A pilot program created as part of a 2018 opioid-related bill signed by Baker authorized sheriffs to offer medication treatment in seven county jails, including Essex and Middlesex.

Middlesex County Sheriff Peter Koutoujian, who offers medication treatment to inmates serving time or awaiting trial at the Middlesex Jail and House of Correction in Billerica, said the commission's report shows more needs to be done both on the inside — and outside — to get people into recovery.

"The fact is you shouldn't have to come to jail to get good treatment," he said. "You should be able to get that in your own community so you don't have to have your life disrupted by becoming incarcerated."

Christian M. Wade covers the Massachusetts Statehouse for The Salem News and its sister newspapers and websites. Email him at

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