{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:21:33Z","timestamp":1789042893198,"version":"build-2803163510"},"reference-count":71,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Despite decades of evidence supporting methadone as a life-saving treatment for opioid use disorder, its delivery in the US has been stymied by stigmatizing dispensation policies that are neither evidence-based nor person-centered. Implementation failures and regulatory challenges have resulted in a significant treatment gap in the US and less than 30% of people with OUD enter and remain in treatment. In this article, we provide a historical overview of the methadone treatment (MT) system in the US and outline why it requires de-implementation. We present the COVID-19 public health emergency as a naturalistic experiment in de-implementation, outline evidence from this period on how COVID-19 related flexibilities influenced treatment outcomes and patient experiences and present a de-implementation framework to contextualize these changes while imagining further expansion of de-implementation efforts to support sustained change. We highlight how patient advocacy can shape further de-implementation while noting current threats to progress.<\/jats:p>","DOI":"10.3389\/fpubh.2026.1951510","type":"journal-article","created":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:02:10Z","timestamp":1789041730000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["De-implementation of inequitable methadone policy and treatment: lessons learned from COVID-19 to support a more just methadone treatment system in the United States"],"prefix":"10.3389","volume":"14","author":[{"given":"Kate","family":"Roberts","sequence":"first","affiliation":[{"name":"Disability Rights California","place":["Sacramento, CA, United States"]},{"name":"Department of Psychiatry and Behavioral Science, University of California San Francisco","place":["San Francisco, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Goodman","sequence":"additional","affiliation":[{"name":"Colorado Drug Policy Coalition","place":["Denver, CO, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Ferguson","sequence":"additional","affiliation":[{"name":"National Survivors Union","place":["Greensboro, NC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Axl","family":"Kaminski","sequence":"additional","affiliation":[{"name":"Department of Sociology, University of California Davis","place":["Davis, CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamika","family":"Spellman","sequence":"additional","affiliation":[{"name":"Grammy's Place","place":["Birmingham, AL, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Luba","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Columbia University","place":["New York, NY, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"103786","DOI":"10.1016\/j.drugpo.2022.103786","article-title":"Has the treatment gap for opioid use disorder narrowed in the U.S.?: A yearly assessment from 2010 to 2019\u201d","volume":"110","author":"Krawczyk","year":"2022","journal-title":"Int J Drug Policy."},{"key":"B2","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1176\/appi.ajp.20220456","article-title":"Performance measurement for opioid use disorder medication treatment and care retention","volume":"180","author":"Williams","year":"2023","journal-title":"Am J Psychiatry."},{"key":"B3","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1186\/s13012-021-01173-5","article-title":"A scoping review of de-implementation frameworks and models","volume":"16","author":"Walsh-Bailey","year":"2021","journal-title":"Implement Sci."},{"key":"B4","doi-asserted-by":"publisher","first-page":"q166","DOI":"10.1136\/bmj.q166","article-title":"Choosing wisely in a time of resource constraints","volume":"385","author":"Born","year":"2024","journal-title":"BMJ."},{"key":"B5","doi-asserted-by":"publisher","first-page":"137","DOI":"10.7326\/M17-3107","article-title":"Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study","volume":"169","author":"Larochelle","year":"2018","journal-title":"Ann Intern Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"e2016228","DOI":"10.1001\/jamanetworkopen.2020.16228","article-title":"Association of treatment with medications for opioid use disorder with mortality after hospitalization for injection drug use-associated infective endocarditis","volume":"3","author":"Kimmel","year":"2020","journal-title":"JAMA Netw Open."},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD002207.pub4","article-title":"Mattick, Mattick RP, Courtney Breen, et al. 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