As WV methadone moratorium challenge continues, local researchers study drug’s efficacy

By: Lori Kersey for West Virginia Watch

A lawsuit challenging West Virginia’s moratorium on methadone clinics argues the drug is particularly effective at treating addiction in those with severe opioid use disorder and those who frequently take fentanyl. Local researchers are studying the drug’s efficacy.

West Virginia capped its number of methadone clinics at nine in 2007. SOAR WV, represented by the American Civil Liberties Union of West Virginia, filed a legal challenge to overturn the moratorium earlier this month in the U.S. District Court for the Southern District of West Virginia.

The lawsuit asserts that addiction is a disability, and that limiting or restricting access to methadone violates Title II of the Americans with Disabilities Act and Section 504 of the Rehabilitation Act.

“Methadone is a very tried and tested treatment,” ACLU legal director Aubrey Sparks told West Virginia Watch. “The science makes clear that it works, and that for some people it is the thing that works best.”

“Because the science is so settled and we know that for some people, it is the best treatment, we’re hopeful that the state agrees with us that this all out ban is unacceptable.”

Sparks said while the moratorium is nearly 20 years old, the harm it causes gets worse year by year as new clinics cannot open and more people go without access to the drug.

“We have just seen in West Virginia over the years what an impact lack of access to adequate treatment has had for people with substance use disorder,” Sparks said. “And we’re seeing that in terms of the HIV epidemic and the widespread HIV that we had in Charleston and Huntington, and the lack of services available to people who are in recovery.”

“Those are all things that I think for anyone who’s interested in West Virginia looking like a better, healthier place 10 years from now, that should be top-of-list,” she said. “And so we saw this (lawsuit) is a way of chipping away at one of those barriers that’s standing in the way of West Virginians being able to be as healthy as they can be.”

The lawsuit asserts that because fentanyl is rampant in West Virginia, access to methadone is even more important. According to preliminary state data, between January and October last year at least 343 drug overdose deaths included fentanyl, and seven involved heroin. In 2024, per the data, 634 residents died from overdoses involving fentanyl. The number of fatal overdoses could increase in the state’s data set as more information becomes available from death certificates.

Ongoing study will compare methadone with buprenorphine

Researchers at PROACT, part of Marshall Health, are part of a three-year national study comparing methadone and buprenorphine. The state Legislature passed a bill during a fall 2024 special session that allows researchers to dispense the drug as part of a medical study.

Methadone has a higher “risk profile” than buprenorphine. It’s rare to overdose on buprenorphine, but more possible to overdose on methadone. Methadone clinics also require patients to come to the clinics daily for their dosage.

Dr. Zachary Hansen, medical director of addiction sciences at the Marshall University Joan C. Edwards School of Medicine and the principal investigator for the study locally, said the study will look into the theory that methadone is better at treating fentanyl-related addiction.

“That’s why we’re doing the study, honestly, to sort of answer that question,” Hansen said. “In science, you have theories, then you have to do the studies to determine whether the theories hold true or not. So there’s a theory that (methadone may be better at treating fentanyl-related addiction) but until we have completed the study and sort of collected enough data, enough research, we can’t make a solid conclusion.”

“That’s why we’re excited to be part of the study,” Hansen said. “We want Appalachia to be represented in this study, and see if it’s something that would benefit our population.”

So far, researchers in Huntington have enrolled 32 patients in the study, with a goal of enrolling 103. About half of the patients will be prescribed buprenorphine and the other half will get methadone.

Hansen said it’s too soon to know what that research will find.

“The data that’s being collected goes to sort of a central database and they’ll sort of do assessments periodically, but we don’t have access to any of that data to really draw any conclusions or any early thoughts about it, as far as what sort of outcomes we’re seeing,” Hansen said.

Lawmaker: Moratoriums are ‘bad policy’

Bills that would end the state’s methadone moratorium have failed in the West Virginia Legislature over the years. West Virginia Watch was unable to reach lawmakers who advocate in support of continuing the moratorium.

Del. Mike Pushkin, D-Kanawha, has supported bills that would end the moratorium. He pointed to a federal ruling in a Mississippi case that struck down that state’s decades-long moratorium on home health agencies, but upheld the certificate of need system program. That judge ruled the ban on new licenses violates the Fourteenth Amendment.

“My argument about methadone clinics is this: putting this artificial cap on the amount of methadone clinics that we can have in West Virginia — hate them, like them or love them — you’re stuck with the same methadone clinics because you just put way more of a value on that license. Because that license isn’t replaceable,” Pushkin said. “So you can’t get another agency, another group, to come in and do it better. You’re stuck with the clinics that you have.”

Pushkin said he’s an advocate for abstinence-based drug recovery, but methadone has its place. Recovery isn’t one size fits all. His objection to the methadone clinic moratorium is more about the policy, he said.

“Moratoriums are just bad economic policy,” Pushkin said. “They’re artificial numbers created by legislatures.”

The state should offer services based on real need and not “made up numbers,” he said.

Charleston drug treatment program open, but not in a hurry to offer methadone

Cabin Creek Health Systems treats about 220 people in its Comprehensive Addiction Recovery Program on Charleston’s West Side. Most patients are treated with buprenorphine, while a handful of patients take vivitrol or naltrexone, the program’s Medical Director Dr. Amanda Borrer said.

Borrer said methadone is still a “gold standard” drug for treating opioid use disorder, and she supports people having access to the drug.

“There are individuals that methadone is what keeps them alive,” she said. “That’s what can keep them from using fentanyl.”

But, she said, the person should have access to a clinic that’s well run, and for the right reasons.

“There can be a difference between methadone clinics that are strictly for profit, not run very well methadone clinics,” Borrer said. “I think there probably are some of those that aren’t really there for the right reasons. So I think that they need access to methadone care, good methadone clinics that are well-staffed with people who have good intentions.”

Having a moratorium on methadone has stifled innovation around treating opioid use disorder, Jake Van Horn, Cabin Creek’s chief program officer, said.

“We don’t, as a state, actually understand how methadone could be effective, because we’ve had 20 years of the same people doing it with no real innovation to practice,” he said. “…That’s more of a statement of just how strategy and interventions get built, not about any particular provider… I’m just saying if we’ve been doing the same thing with a product for 20 years, do we really know what it’s capable of? And there isn’t the ability to innovate new intervention related to methadone if there’s a moratorium.”

Van Horn said if the moratorium were lifted, Cabin Creek would not be in a hurry to add methadone to its treatment options, but the clinic would be open to the discussion. Van Horn said he wouldn’t know where to begin to scale the program to offer methadone.

There would be different requirements for storage, staffing, dispensing and providing in general, he said.

“If I understand correctly, well-run (opioid treatment programs) have programs and interventions that are specific to methadone,” he said. “It’s just not something we have experience with, and learning about it would take time and resources, if we decided to go in that direction.”

“We are open to (evidence based treatments), but we’d have to explore the feasibility of adding it as an intervention.”

West Virginia Watch is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. West Virginia Watch maintains editorial independence. Contact Editor Leann Ray for questions: info@westvirginiawatch.com.