Expanding Access to Buprenorphine and Methadone: Global Perspectives and Policy Recommendations

Opioid-related deaths remain a major cause of preventable mortality, but access to medications for opioid use disorder (MOUD) such as methadone and buprenorphine remains restricted globally. This review compares national MOUD policies across 8 countries (the United States, Canada, the United Kingdom, Russia, France, Iran, Australia, and Portugal) to examine how regulation may affect treatment coverage, mortality, and system responsiveness. Secondary aims include identifying barriers to MOUD access and illustrating potential lives saved and economic gains from expanded U.S. coverage.

A targeted narrative review of peer-reviewed and policy literature characterized methadone and buprenorphine regulations, prescriber eligibility, dispensing models, and coverage across countries, with opioid-related mortality data drawn from the Global Burden of Disease Study 2021. A U.S. modeling analysis estimated overdose deaths averted and economic savings at increasing levels of MOUD coverage using national prevalence data, meta-analytic mortality reductions from treatment, and Centers for Disease Control and Prevention economic valuations adjusted for treatment costs.

Regulatory bottlenecks including daily supervised dosing, restricted community prescribing, and stigmatizing drug scheduling limit MOUD access. International models demonstrate feasible alternatives: in the U.K. and Australia, community pharmacy dispensing supports reach without compromising safety; in France, liberal buprenorphine prescribing through primary care facilitated rapid national scale-up; in Portugal and Iran, decriminalization and expansion of flexible, low-threshold public health-integrated models coincided with reductions in overdose deaths. In contrast, Russia's prohibition underscores the harms of abstinence-only policies. Increasing U.S. MOUD coverage to 25% could prevent about 3500 overdose deaths annually, and universal coverage could avert over 41 000, yielding $38 to $444 billion in net economic savings.

International evidence suggests that regulatory reform and integration of MOUD into mainstream healthcare can expand access and reduce mortality. Aligning policies with these lessons, by decentralizing methadone delivery, modernizing buprenorphine scheduling, and embedding MOUD within public health systems, represents both a public health and economic imperative.