AMNA NAWAZ: While the numbers are finally starting to decline, more than 74,000 Americans are still dying every year from opioid overdoses.

Despite that, very few people struggling with addiction get treatment.

Tonight, William Brangham looks at the renewed focus on methadone, one of the oldest and most effective medications in this fight.

NATALIE KNIGHT, Methadone Patient: They give me 27 days at a time.

WILLIAM BRANGHAM: For Natalie Knight, what's in these little white bottles has turned her life around.

NATALIE KNIGHT: It's nasty.

WILLIAM BRANGHAM: That pink liquid is methadone, and it's helped her tame an opioid addiction that she has struggled with for close to a decade.

NATALIE KNIGHT: Actually, such a small amount, but it really is -- it's amazing that I don't get the highs, I don't get the lows, I don't get anything that I would get on a normal opiate.

WILLIAM BRANGHAM: Her path to addiction was like millions of others, a legal opioid prescription to help with chronic pain caused by an autoimmune disorder and a difficult pregnancy.

At first, it really helped, but, within a few years, she could not stop, and her life began to unravel.

NATALIE KNIGHT: I was still trying to be a wife and a mother, which I was failing at both, and I was not able to hold a job, because, when you run out of pills every three days, opiate withdrawal is excruciating.

It's excruciating, and you're sweating and freezing at the same time.

WILLIAM BRANGHAM: I can't imagine doing anything like that.

NATALIE KNIGHT: Yes.

And every single day revolved around finding what I needed, even if it was just to get me through the next day.

I got him as a puppy.

WILLIAM BRANGHAM: She tried several other treatments, including Suboxone, a medication that helps curb the cravings for opioids, but it wasn't enough.

So, last year, she was prescribed methadone.

It's a potent opioid itself, first approved for drug treatment in the U.S. in the 1970s.

NATALIE KNIGHT: If I hadn't made the move when I did, I don't think I would have been living much longer.

I don't think I would have lived today.

I should have died 100 times over.

WILLIAM BRANGHAM: But for many Americans battling opioid addiction, getting methadone isn't easy.

It can only be prescribed in federally regulated methadone clinics.

And, nationwide, there are only about 2,000 of them.

Eighty percent of U.S. counties have none.

DR. PAULA COOK, Moab Regional Recovery Center: OK, well, because you're still working two jobs?

WILLIAM BRANGHAM: So, once a month, Knight makes the trip from her home in rural Utah to see Dr. Paula Cook.

She's the medical director at the Moab Regional Recovery Center.

DR. PAULA COOK: How's the methadone going?

NATALIE KNIGHT: I don't have any withdrawals.

WILLIAM BRANGHAM: This clinic has only been here for two years.

And before it opened, the nearest one was 120 miles away.

DR. PAULA COOK: We're unique.

Very few rural towns have a methadone clinic.

Some states don't have a methadone clinic.

WILLIAM BRANGHAM: In these clinics, patients often get other services, like counseling and behavioral therapy.

WOMAN: That's the blood pressure before you take your methadone.

So that's probably -- after you take it, it'd be a little lower.

WILLIAM BRANGHAM: And decades of research has shown that methadone can cut the risk of overdose death by nearly 60 percent and that people on it are four times more likely to stay in treatment.

Given all of that, why is methadone still so hard to access?

DR. PAULA COOK: Because it is an opioid, so we're giving someone a substitute therapy, which in essence is somewhat true.

You're giving them an opioid to treat and opioid addiction, but the outcomes are very different.

Most people who get on methadone actually stop using illicit opioids.

They actually retain in treatment and get a job and stop going in and out of the criminal justice system.

DAVID FRANK, Research Scientist, NYU: The very first day, I went to my methadone clinic, and I had taken my first dose, I was walking back to my apartment, and I was like, my God, I'm not going to get dope-sick today.

And I'm not going to have to do any of the stuff I have to do every day to alleviate that dope sickness.

And not only that, they're going to give me another dose tomorrow.

WILLIAM BRANGHAM: David Frank has taken methadone for nearly 20 years after he became addicted to heroin in the 1990s.

Today, Frank is a research scientist at New York University who studies opioid use and drug policy.

He credits methadone with helping him get his Ph.D. and turning his life around.

What about the argument that you often hear that you're simply substituting the addiction of one drug with the addiction to another drug?

DAVID FRANK: It's almost like, so what?

When I got on methadone, I swapped taking an illegal criminalized, stigmatized drug that was very difficult to access and could only be obtained on an illegal market and never with any kind of knowledge about what your dose would be for a consistent, stable, legal drug that I could access every single day at my methadone clinic or for my take-home doses.

WILLIAM BRANGHAM: For decades, because of fears that people would take too much or sell their doses, most patients were required to show up every day at a clinic to take their methadone under close supervision.

Many patients criticized those rules, saying they made it extremely hard to hold down a job or live a normal life.

But, this October, emergency measures that were introduced during the pandemic... WOMAN: You're all set.

WILLIAM BRANGHAM: ... were made permanent in many states.

These rules give clinicians more flexibility to let patients like Natalie Knight take home up to a month's worth of methadone at a time.

DR. PAULA COOK: It's a gold standard evidence-based medication.

We don't put barriers up for medications like insulin.

We allow people who have diabetes to have access to insulin and we don't require them to participate in an antiquated system that's stigmatizing that some people can't access at all actually because of the nature of their condition.

WILLIAM BRANGHAM: Last year, a bipartisan group of lawmakers introduced legislation that would allow more doctors and specialists to prescribe methadone and would expand the kinds of places where patients could get it to places like pharmacies.

But that legislation stalled and made concerns among some in the medical community that loosening methadone safeguards could backfire.

DR. KENNETH STOLLER, Johns Hopkins University School of Medicine: People who are just starting on methadone are actually at a higher risk of overdose for the first couple of weeks than before they even started on this medication.

So the initiation of this medication can be quite tricky.

WILLIAM BRANGHAM: Dr. Kenneth Stoller is an addiction psychiatrist at Johns Hopkins University and he directs an opioid treatment program in Baltimore that prescribes methadone.

He says it is not a silver bullet on its own, that people battling opioid addiction really benefit from the additional support clinics often provide.

DR. KENNETH STOLLER: If people are getting medication within a setting that is not addressing their needs, their social needs, their medical needs, their mental health needs, all the barriers to treatment that they have, their outcomes just won't be as good as if people were going to comprehensive treatment.

WILLIAM BRANGHAM: You also hear concerns about methadone from within the recovery community.

Some argue it's still a drug and getting off methadone can be as difficult and painful as trying to quit other opioids.

They argue abstinence through programs like Narcotics Anonymous is the better path.

Some others who've used methadone paint a more complicated picture.

Getting on methadone saved my life.

Getting off of it gave me a life.

RYAN DUXBURY, Former Methadone Patient: He was revived with Narcan from someone from our team.

WILLIAM BRANGHAM: We first met Ryan Duxbury back in 2017 while reporting on the opioid crisis in Rhode Island.

He took methadone for six years to get over his OxyContin addiction.

He eventually got off methadone and now credits his sobriety to abstinence and support from peers.

RYAN DUXBURY: I had to go to the methadone clinic in a fairly seedy neighborhood, and I had to be there every day.

Still, I'm trying to find recovery and I'm trying to change my environment a little bit.

And still standing in line outside in the cold with people that I used with wasn't very helpful.

WILLIAM BRANGHAM: Do you think if you would been given 30 days' worth of doses to take home, that that would have helped?

RYAN DUXBURY: I do think that would have been better for me, but I wish that there were more support in terms of me being able to become more productive as a member of society.

DR. PAULA COOK: So, today, I'm going to send her with some medication.

WILLIAM BRANGHAM: Back in Utah, Dr. Paula Cook says, today, because fentanyl is so prevalent and so potent, increasing access to methadone is critical.

It's why she supports allowing it to be prescribed outside of clinics like hers.

DR. PAULA COOK: Come in.

Have a seat.

Is there a risk?

Of course there's a risk.

That's why it requires good stewardship.

But I'm 100 percent sure it's the right path, because that's what the evidence shows.

And that's what people who have opioid use disorder have demonstrated.

And improving access will reduce loss of lives.

WILLIAM BRANGHAM: Natalie Knight says methadone is slowly helping her rebuild her life.

Could you have envisioned who you are today and how you're living today?

NATALIE KNIGHT: No, I never envisioned that I could have a life like everybody else has.

I'm able to work two jobs and not go through withdrawal, but also not be in pain.

I am able to be a mother.

I am able to be a sister again.

It's changed my whole life.

WILLIAM BRANGHAM: For the "PBS News Hour," I'm William Brangham in Moab, Utah.

AMNA NAWAZ: Tomorrow, we will look at why medications are so rarely prescribed for people who struggle with one of the most commonly used and deadliest drugs, alcohol.