More than 2 million Americans have an opioid use disorder (OUD). Although untreated OUD is devastating, most persons who are treated achieve remission, particularly with opioid agonist therapy (OAT), which includes such medications as methadone and buprenorphine. Each year, 12.5 million buprenorphine prescriptions are filled in the United States and 350 000 persons receive methadone (1, 2). This growing population has unique health needs, with higher prevalence of conditions that may require organ transplant, such as hepatitis C. Yet, persons with OUD may be deemed ineligible for transplant, even when they are successfully treated with OAT (3, 4). Excluding OAT recipients who could benefit from transplant may exacerbate disparities and is not based on evidence. Requiring patients who are receiving OAT to meet higher standards for pretransplant adherence also sanctions differential treatment. Moreover, requiring patients to stop OAT before transplant forces a choice between a high risk for relapse and overdose death or organ failure. Failing to treat patients with OUD similarly to those with other medical conditions violates the principles of beneficence, nonmaleficence, and justice.
My rule of thumb for hepatitis C therapy is to not start until after 2 years of OAT without relapse, others may use shorter or longer intervals. Folks getting the gold standard should be able to be on transplant lists if they’re working a good recovery program. I remain a big fan of the “12-Step” programs!