There are 562 opioid treatment programs (OTPs), colloquially called methadone clinics, that are owned by private equity-backed providers, according to a new analysis by STAT.
The analysis also finds that this represents “nearly one-third” of all OTPs. It further contends that private interests are gaining an outside influence in the industry. It was conducted as part of a wider assessment of the years-long lobbying effort by OTP advocates to protect these facilities’ monopoly on the distribution of methadone for treating opioid use disorder (OUD).
The OTP space has primarily been a for-profit endeavor for years. It has increasingly been so in the last decade.
In 2011, about 55% of OTPs were operated by private, for-profit entities. Meanwhile, 35% were operated by nonprofits, and 9% were operated by government entities, according to industry survey data from the Substance Abuse and Mental Health Services Administration (SAMHSA).
More recent industry survey data from 2020 shows that about 62% of OTPs are operated by private, for-profit entities.
STAT highlights the increased antagonism between the OTPs and the federal government. There has been increased interest in allowing clinicians to prescribe methadone for OUD outside of the confines of OTPs, a move the industry has opposed. Lawmakers have pushed back just as firmly.
“They don’t want to surrender the profits that come from having a monopoly,” Sen. Ed Markey, a Democrat from Massachusetts, told STAT.
A specific flashpoint is the Modernizing Opioid Treatment Access Act (MOTAA), of which Markey is one of the bill’s cosponsors. It was filed in March 2023 and would allow for the unsupervised use of methadone that’s prescribed by a provider affiliated with an OTP of a doctorate-level provider with certification in addiction medicine.
Several organizations have spoken out against the bill. Some include the American Association for the Treatment of Opioid Dependence (AATOD), the National Association for Behavioral Healthcare (NABH) and Program, Not A Pill. The latter is a recently formed single-issue group whose partner organizations include Acadia Healthcare (Nasdaq: ACHC), AATOD, BayMark Health Services, Behavioral Health Group, Carolina Treatment Centers, Crossroads Treatment Centers, New Season and Western Pacific Med Corp.
Acadia Healthcare and BayMark Health Services are among the titans of behavioral health.
Critics of the effort to deregulate methadone say that it puts patients at risk of overdose, puts too much focus on medication within addiction treatment and that the effort would not translate to increase methadone utilization — they cite the example of the now defunct X waiver.
