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- Methadone is highly effective at reducing illicit opioid use and overdoses.
- The federal government sets minimum standards for clinics to prevent misuse, but Wisconsin imposes more than a dozen additional requirements on providers.
- As a result, patients may wait longer to begin treatment, make daily trips to clinics and take more time to reach an effective dose.
- Many other states have eased their rules, expanding access without compromising patient safety.
After years of opioid use, Bob saw three paths ahead: jail, death or methadone.
The 70-year-old Stevens Point resident chose methadone, which he has stuck with for more than half his life. He credits the treatment for his long career and ability to raise two daughters. Now retired, he sits in a recliner holding a sheet of paper with a list of old friends; he’s written “OD” next to the names of several loved ones killed by drugs.
Methadone is highly effective at reducing illicit opioid use and overdoses, experts say. It reduces drug cravings, prevents withdrawal and can provide stability without a mind-altering high.
More than 10,000 Wisconsinites used methadone treatment in 2024 to recover from opioid use disorder. But state regulations make accessing treatment more difficult for those patients, providers and researchers say.
The federal government sets minimum standards for clinics providing methadone treatment aimed at preventing misuse. Wisconsin adds more than a dozen more restrictive requirements, according to the Pew Charitable Trusts.
For patients, the state’s laws can mean waiting longer to enroll in treatment, daily drives to the clinic — even on weekends and holidays — and waiting longer to reach an effective dose.
Two years after the federal government relaxed its rules, Wisconsin’s landscape remains largely unchanged. Providers and researchers want Wisconsin to catch up with newer standards adopted by other states, including Minnesota, Michigan, Illinois and Iowa.
The Department of Health Services is reviewing Wisconsin’s rules, but it’s unclear what will change or when.
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Long drives for methadone treatment
Bob wakes up at 4:30 a.m. and starts the 40-minute drive to his treatment clinic. Years ago, he left that early to make it to work on time. Now, he just likes to beat the crowd.
Wisconsin Watch is identifying people who use methadone by first name only to protect their private health information.
Bob tries not to pee before starting the drive. He knows clinic staff will likely send him into the bathroom with a cup as soon as he arrives. It’s been two decades since he used drugs or alcohol, but he takes the drug test all the same.
Next, he walks up to a clinic window, where someone hands him 13 plastic bottles of a cherry red liquid. Bob locks the medications inside a box he brought from home. A staff member watches as he swallows another dose.
He’ll do it all again in 13 days. The treatment saved his life, but it keeps him tied to this time-intensive routine — and to a clinic in another town.
“Methadone is like having a pair of golden handcuffs,” he says.
Unlike other medications, methadone cannot be picked up from a pharmacy. Only 31 locations across Wisconsin are approved to provide medication-assisted opioid treatments including methadone, according to the state health department.
At the state’s northernmost clinic in Wausau, patients traveled an average of 31 miles, one way, to their clinic in 2024.
Wisconsin allows fewer take-home doses
Methadone can be fatal if misused. To prevent people from overusing it or selling it, the federal government limited the number of take-home doses patients receive.
Early in the pandemic, the federal government allowed states to to relax take-home rules to limit crowding at clinics — and many states did so. Studies later showed higher patient satisfaction and feelings of being respected without a significant increase in misuse.
In making the pandemic exceptions permanent in 2024, federal regulators wrote that the previous standards “can pose disruption to employment, education and other daily activities for patients, and several of the criteria reflect outdated biases that promote stigma and discourage people from engaging in care.”
But Wisconsin’s take-home regulations remain stricter than the federal minimums from before the pandemic.
The federal standard allows patients like Bob to take home 28 doses at a time. Wisconsin allows only 13.
Wisconsin patients must visit their clinic seven days a week until they complete a month in treatment and meet other criteria not required by the federal government. It takes a year in Wisconsin to qualify for the number of take-home doses providers in other states can offer patients after two weeks.
Random callbacks disrupt routines
State rules also require clinics to regularly “call back” patients, like Bob, who have more than two take-home doses. The callbacks are intended to help providers make sure patients are not selling or misusing take-home doses.
Between visits, Bob’s provider often calls and tells him to arrive at the clinic within 24 hours with all 13 methadone bottles. If he doesn’t, he has to go back to daily clinic visits.
Federal rules do not require callbacks. In a 2024 report, federal regulators said providers should “consider the disruptive nature of random callbacks.”
It’s hard to make plans knowing you might have to change them any moment, Bob says. “I want to be normal again.”
Rules changes under review
Wisconsin is an outlier whose policies are overdue for an update, said Sharel Rogers, CEO of Addiction Medical Solutions and Vin Baker Recovery. She also serves as president of the Wisconsin Association of Treatment for Opioid Dependence.
Rogers was among several providers who backed a bill last month to update state rules. The measure was introduced right before the legislative session ended and was not expected to pass, but supporters hoped it would push regulators to act.
Wisconsin health officials are considering changing opioid treatment regulations, but without legislative action, the process could take years.
The Wisconsin Department of Health Services aims to ensure state regulations support access to “high-quality, evidence-based care for those who need it,” wrote Elizabeth Goodsitt, a spokesperson for the agency.
The agency started the state’s “intentionally thorough” rulemaking process last year to bring state regulations “closer in alignment with current federal regulations,” Goodsitt said.
The agency is still drafting proposed changes. They would be subject to public hearings and lawmaker approval in a process that ensures input from providers, advocates and patients, Goodsitt said.
The health department declined to answer detailed questions. Staff plan to review enrollment and take-home requirements, according to a document submitted to the Legislature. It’s not clear if other discrepancies, like callbacks, lab testing or dosage levels, will be addressed.
Opioid treatment providers should be carefully regulated, but Wisconsin’s current rules create barriers for patients, Rogers said.
“I’m just amazed at these patients every day, what they will do for their own recovery,” she said.
Recovery under tight restrictions
Timothy overdosed three times before starting treatment.
After nine months in Marathon County jail, he relapsed unaware of his lowered tolerance and the strength of the drug supply in 2022.
Within a couple of months, he started methadone.
“Some people don’t get out of that. A lot of people don’t,” Timothy said. “I’m grateful.”
Opioid overdose deaths dropped by more than 42% in Wisconsin between 2023 and 2024, according to the state health department. Still, opioids killed 815 people in Wisconsin in 2024, compared with fewer than 300 deaths two decades earlier.
Rising overdose rates are driven in part by fentanyl, a more potent opioid. Patients with a history of fentanyl use typically need higher methadone doses, said Dr. Hillary Tamar, who oversees Wisconsin treatment providers as a medical director for Community Medical Services.
Wisconsin rules prohibit providers from giving new patients a starting dose above 30 milligrams of methadone. That limit is outdated in the fentanyl era, Tamar said. The average dose at most Wisconsin clinics in 2024 was above 100 milligrams.
Updated federal limits allow providers to start patients at 50 milligrams or higher, based on their clinical judgment. A higher starting dose can help patients avoid withdrawal and reach a stable dose sooner, Tamar said.
Federal regulations also give providers greater ability to decide whether a patient may benefit from fewer visits.
“The regulations in Wisconsin bind us to creating a one size fits all plan, and that is just not how humans work,” Tamar said.
Despite attending regular counseling and dosing in-person daily for four years, Timothy still doesn’t qualify for a single take-home dose in Wisconsin.
That’s because he started using cannabis while undergoing chemotherapy around the time he started methadone treatment. Now in remission, he is working with his counselor to stop using cannabis, but it still prevents him from receiving take-home doses in Wisconsin.
In other states, marijuana use does not bar patients from receiving take-homes, Tamar said.
Last month, Timothy received two take-home methadone bottles while visiting his daughter in Florida.
Before leaving Wisconsin, he worked with staff at his clinic to set up a week’s worth of visits with a Florida provider. He was surprised when the new clinic told him he would receive take-home doses over the weekend.
When at home in Wisconsin, Timothy doesn’t mind the daily clinic visits. But when he’s with his daughter, they remind him of his past mistakes.
For two days he mixed his medication with apple juice and celebrated his 45th birthday with his family without stopping at the clinic.
He said it was the best time of his life.
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