Two senators are renewing their push to greatly expand access to methadone treatment for opioid addiction.
On Thursday, Sens. Ed Markey (D-Mass.) and Rand Paul (R-Ky.) are introducing an updated version of legislation that would allow doctors who hold board certifications in addiction medicine to prescribe methadone directly to patients for pickup at a pharmacy.
Currently, methadone is available as an addiction treatment only at roughly 2,000 specialty clinics. Many of those programs have required patients to attend the clinic each day in person to receive their methadone dose. Federal reforms enacted in 2024 have allowed those facilities, known as opioid treatment programs (OTPs), to exercise more flexibility with patients, though it remains unclear how meaningfully patients’ experience has changed in recent years.
Markey first introduced the legislation in 2023. The Senate Committee on Health, Education, Labor, and Pensions approved the bill on a bipartisan basis in December of that year, though it never received a full Senate vote, and the bill failed to gain traction in the House of Representatives.
“For too long, we have kept methadone — an evidence-based, life-saving medication — locked away, far from many of the people who need it,” Markey said in a statement to STAT. “The ‘Modernizing Opioid Treatment Access Act 2.0’ would take a carefully considered step forward in expanding access to this medication by allowing the most highly trained addiction physicians in the country to prescribe methadone for their patients to pick up at a pharmacy.”
The new version of the legislation also allows the Department of Health and Human Services to designate additional providers who are permitted to prescribe methadone directly without requiring further action from Congress.
Methadone is one of just three medications approved by the Food and Drug Administration to treat opioid addiction. Along with another of the medications, buprenorphine, methadone has historically been stigmatized because it is itself an opioid. Both medications prevent cravings and debilitating withdrawal symptoms among people who previously used heroin or fentanyl by binding with the same brain receptor. When administered properly, however, the medications merely help patients achieve clearheadedness and physical comfort, rather than inducing a high.
As the opioid crisis accelerated, methadone clinics have received increasing scrutiny regarding their patient practices.
A 2024 STAT investigation showed that private equity firms have acquired stakes in roughly one-third of all methadone clinics nationwide. Many of the private equity-backed clinic chains, in concert with a major trade group representing methadone clinics, launched a lobbying and public relations blitz in 2024 aimed at preventing Markey and Paul’s legislation from becoming law.
The trade association, the American Association for the Treatment of Opioid Dependence, led a campaign titled “Program, Not a Pill,” which argued that OTPs don’t just offer the medication but rather a comprehensive suite of services, which include methadone dosing in addition to counseling.
Patients, however, have increasingly argued that the treatment they receive at methadone clinics has hampered their care. Clinics are known to require frequent drug testing, with urine sample collection sometimes observed on camera or in-person, and requiring daily in-person attendance at the clinic for months or even years on end. For patients who eventually receive take-home medication, some clinics still engage in “call-backs,” wherein the patients are required to show up with each of their take-home doses on hours’ notice to prove they haven’t been misused or sold.
In the wake of STAT’s investigation, Markey and Sen. Maggie Hassan (D-N.H.) launched separate investigations of the private equity firms known to have purchased stakes in methadone clinics.
Markey and Paul’s bill introduction comes as the political landscape surrounding medications for opioid use disorder has shifted. In April, the Trump administration wrote an open letter to addiction treatment providers warning that the medications should not be used “as a default sentence to life-long medication use.” A top HHS official, prior to his appointment as the agency’s general counsel, was best known in the drug policy world for introducing legislation in West Virginia that would have effectively banned methadone treatment entirely.
And last year, a Republican congresswoman introduced legislation that would have rolled back the new flexibilities enacted in 2024 by the Substance Abuse and Mental Health Services Administration, in effect forcing patients to once again attend methadone clinics daily and submit themselves to mandatory drug tests, counseling, and other potential stumbling blocks at their clinics’ discretion.
The legislation has already gained substantial support across the drug policy and recovery advocacy landscape. An endorsement list reviewed by STAT prior to the legislation’s introduction featured advocacy groups and medical societies including Faces & Voices of Recovery, the American Society of Addiction Medicine, the Drug Policy Alliance, the R Street Institute, and the Legal Action Center.
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