This is a guest opinion column

Alabama is making progress in the fight against an opioid crisis that’s wracking our state and nation. The state has seen a 20.6% decline in the number of drug overdose deaths between September 2023 and September 2024, according to the Centers for Disease Control and Prevention. Nationwide, there has been a 23.7% drop in drug overdoses over the same period.

Policymakers at the state and federal levels should be proud of the progress. First, the federal government required Medicaid to cover opioid treatment programs (or OTPs), which has helped people get the treatment they need.

More recently, Alabama adopted federal policy changes that gave clinicians more flexibility in how they personalize treatment for their patients. Those changes have improved treatment and convenience, allowing doctors to prescribe up to 28 days of methadone doses for stable patients to take home – a big change from the previous policy requiring daily in-person visits at our clinics and requiring patients to have two years of treatment before getting a month’s worth of medication. And they have dramatically accelerated the time it takes to get our patients to the most effective dose of medication.

Already, we can see improvement. With more take-homes allowed, we saw an almost 11% reduction in patient dropouts in our network in the first three months since the changes took place.

On dosing, older regulations limited how quickly OTPs could raise the amount of medication to an effective level. The changes enabled us to go from 23% of patients achieving a minimum therapeutic dose of methadone within 30 days up to 75% as recently as last month. This is hugely important – and potentially lifesaving. The more rapidly we can get a patient to the minimum therapeutic dose, the lower the chances are that they will turn to fentanyl, which is so prevalent in our communities.

OTPs are the only providers that can provide methadone treatment. Methadone, combined with wraparound psychosocial support, counseling and care coordination from trained health professionals is widely recognized as the most effective way to help people maintain long-term recovery and avoid dangerous relapses.

These wraparound services help patients not only stabilize their health but also improve their overall well-being. The ability to remain in treatment means more opportunities to find and keep jobs, afford stable housing, and strengthen relationships with family and friends — critical factors in long-term recovery.

Keeping people with opioid use disorder in treatment is the most effective way to keep them alive. Any lapse can put them at risk — especially at a moment when fentanyl is far more available and dramatically more lethal than OxyContin and heroin. With a fentanyl overdose, there are no second or third chances. We are in a race against the potency and the availability of that poison.

That’s why those of us working on Alabama’s frontline OTPs are so deeply committed to helping patients regain and maintain fully functional lives. The changes at the federal and state level have helped, but we need to ensure that policymakers continue to remove barriers that prevent people from accessing and staying in treatment.

While this news is encouraging, it’s much too soon to declare victory. If this were a football game, we wouldn’t even be at halftime. Limited access and the recent discussions of Medicaid cutbacks puts our progress in jeopardy.

See report: Alabama Medicaid could lose more than $800 million under GOP plan: ‘It’s going to affect us hugely’

Congress and state governments need to discuss what more can be done to expand access to treatment to improve retention — not cutting Medicaid. Ensuring adequate public funding, increasing reimbursement rates and expanding geographic access are three important steps our policymakers could take in removing barriers and expanding treatment.

Alabama’s Medicaid reimbursement for OTP services is only 47% of what Medicare pays, and only about 10% of our patients are on Medicare. This makes it harder to expand and sustain treatment options. Raising these rates would allow more people access to quality care. Certainly, any decrease in Medicaid benefits would have a determinantal impact.

At any given time, the network of OTPs I oversee has about 5,000 patients in treatment. Medicaid provides coverage for about 20% of them, and about as many are on an Affordable Care Act exchange plan. Cuts to these programs could leave thousands without care that is literally keeping them alive and well.

Lastly, treatment has to be accessible. According to the 2020 census, Alabama is the eighth most rural state in the country with 42.3% of our population living in rural areas. Mobile and satellite OTP treatment units have proven effective across the country in reaching people in rural areas, but Alabama has yet to permit them.

Additionally, restrictions on new licensed facilities limit the ability to serve those who live far from existing OTPs.

The progress we’ve made is just the beginning. If we want to turn these short-term gains into sustainable change, we must fully unleash the potential of methadone-assisted treatment. By reducing barriers and expanding access, we can save more lives and give people with opioid use disorder a real chance at lasting recovery and full, functional lives.

Matt Broussard is the Area Vice President of Operations at Behavior Health Group, which manages the largest network of opioid treatment programs across Alabama.