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Nobody has made more of an impact on methadone treatment than Mark Parrino.

For decades, he’s served as the founder and president of the American Association for the Treatment of Opioid Dependence, a nationwide advocacy group representing methadone clinics. Before AATOD, he ran a statewide advocacy group in New York, having made the jump to politics and policy after working as a clinic director and, before that, as an addiction counselor.

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Now, a half-century after he began his career in addiction treatment, Parrino is facing what is perhaps a career-defining fight. In the last few years alone, the nation’s tone on opioid treatment programs (OTPs), as they are known, has shifted significantly. While methadone has long been stigmatized, a growing coalition of advocates, lawmakers, and addiction doctors is now pushing to significantly deregulate methadone treatment — and in particular, to offer it outside the context of the specialized clinics that Parrino has long represented.

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