The new year is upon us. After a year of uncertainty in the substance use disorder (SUD) treatment industry, interested parties are looking for hints of what’s to come in 2025.
Yet more pinnacles and valleys may be in store.
Looking ahead to 2025, new treatment techniques and regulations spell good fortune for patients and providers. A new administration and other regulations could complicate the pursuit of evidence-based, accessible SUD treatment.
Over the last decade medication-assisted treatment has become the gold standard in SUD treatment. Yet these medications often carry stigma and significant access hurdles. The industry could see real benefits from increased flexibility to prescribe scientifically proven medications. Medication access could change significantly in 2025, possibly thanks to decreased regulation and more clinician autonomy
The new administration’s approach to these medications is still unclear, but there is hope that patients will have better access to care than ever before in the upcoming year.
Methadone prescribing will increase
Research suggests that methadone may be the most effective treatment for opioid use disorder (OUD) OUD, outpacing buprenorphine in keeping patients in care.
Despite its efficacy, the field of methadone prescribing is one long troubled by burdensome regulations. In 2024, the Substance Abuse and Mental Health Services Administration (SAMHSA) cemented COVID-era methadone prescribing flexibilities – although some states have opted for more stringent guidelines.
Despite differences across state lines, methadone prescribing could make significant progress in 2025. SUD treatment provider Pinnacle Treatment Centers has already launched its methadone tele-prescribing practice, getting special permission from the state of California to abide by federal regulations and prescribe virtually while the state finalized its own guidelines.
More providers are likely to move this way in 2025, potentially saving many patients’ lives through enhanced access to methadone.
Brick-and-mortar methadone clinics may also increase in number in response to the growing body of evidence suggesting that methadone is the finest treatment for OUD.
“I believe we may see growth in the number of methadone clinics operating within our communities,” David C. Guth, Jr., CEO of Centerstone, previously told ATB. “A recent JAMA article compared discontinuation rates between patients on buprenorphine/naloxone and those on methadone, finding that methadone was associated with a lower risk of treatment discontinuation.”
Centerstone is a not-for-profit mental health care and SUD treatment provider serving Florida, Georgia, Illinois, Indiana, Kentucky and Tennessee. It also operates a research institution and a philanthropic foundation.
Investment and M&A will rise for evidence-based providers
Many behavioral health segments have begun to recover from the dealmaking downswing of 2023. The SUD treatment industry has not been one of those segments.
Some of the sluggish rebound has been due to the decline of luxury residential SUD treatment. Outpatient care, often preferred by payers for its relative affordability, is on the upswing. Outpacing the rest of SUD specialties is medication-assisted treatment, according to Dexter Braff, founder and president of the Braff Group.
“From a spending standpoint of the federal government, state governments, and even individuals an [medication-assisted treatment] (MAT) program could be far, far, far cheaper than a residential,” Braff said.
With favorable macro-economic factors like interest rates on investors’ sides, the behavioral health industry at large is poised for a strong return to dealmaking. Given these factors, SUD treatment providers are likely to see an improved environment for M&A and funding.
The digital SUD space, in particular, could be ripe for dealmaking, though high patient acquisition costs are a key barrier to digital companies.
On the upside for virtual prescribers of controlled substances like buprenorphine, no major changes from the Drug Enforcement Agency (DEA) are anticipated to impact prescribing in 2025. In September, the DEA extended the deadline for telehealth flexibilities for the third time, leaving the fate of digital MAT safe for another year.
Benefits and complications from the Mental Health Parity and Addiction Equity Act (MHPAEA)
Parity has been an enduring issue for all areas of behavioral health care, including SUD treatment. Health insurance companies persistently refuse to comply with parity requirements, making it more difficult for patients to access care and for providers to receive adequate reimbursement.
A key new regulation released in September 2024 promises to improve the status quo. The Mental Health Parity and Addiction Equity Act (MHPAEA) updates the extent to which health insurers can limit behavioral health benefits – and is a “step in the right direction.”
However, SUD treatment providers may struggle with the implementation of the ruling in 2025.
“When you look at it in a vacuum, it sounds excellent,” Dr. Tamir Aldad, founder and CEO of Mindful Care, said at BHB’s INVEST event. “As a clinician, certainly we support parity. It is in everyone’s best interest. But when you look at it holistically, we might be in for some turbulence when we try to see how sustainable it is across everyone involved.”
West Hempstead, New York-based Mindful Care provides virtual and in-person psychiatry and therapy.
To minimize choppy waters associated with the initial stages of the new ruling, providers will likely need to work with their health plans to ensure compliance moving forward.
Innovative techniques
New tactics for treating patients also stand to become increasingly common within the next year.
In particular, wearable technology and GLP-1 agonists like Ozempic and Wegovy stand to make real change in the SUD industry.
Wearable technologies can track physiologic or behavioral parameters and offer targeted interventions when a heightened risk of relapse is detected. For example, increased heart rate is associated with cravings for illicit substances. A wearable tracker detecting a craving provides time for an intervention.
These technologies are not brand new, but research continues to suggest that such devices could be a crucial aid to treating SUDs in America.
GLP-1 agonists represent another novel tool for treating SUDs. A recent study found that 45% of patients who drank any amount of alcohol when initiating a course of treatment with weight-loss drugs decreased their alcohol use over the course of two years.
Providers have a keen interest in the drug’s ability to curb cravings for illicit substances.
“As evidence continues to mount, including the research we’ve done, about the benefits of GLP-1 medications to reduce cravings, we will see these more integrated into clinical practice,” John Driscoll, president and CEO of Caron Treatment Centers, previously told ATB. “We’ll also see the movement of more treatment providers expanding their services into primary mental health.”
Wernersville, Pennsylvania-based Caron is a nonprofit SUD treatment provider operating in Pennsylvania, Florida, Washington, D.C., Georgia and New York.
Researchers and a few providers may continue to demonstrate potential use cases. Wearable technology, in particular, may grow in popularity throughout the upcoming year.
Uncertainty from a new administration
Many herald the upcoming Trump-Vance administration as ideal for company growth, which could benefit SUD treatment providers. Still, the differing rhetoric from the incoming administration’s leadership could further inhibit patients from getting this gold-standard treatment.
Stigma related to substance use disorders and evidence-based SUD treatments like medications for opioid use disorder (MOUD) keep many patients from getting care (and stop some clinicians from helping patients access the best care).
The most effective treatment for OUDs are MOUDs, like methadone and buprenorphine.
Robert F. Kennedy, Jr – a man who seems to suggest that the decision to believe in God increases chances of recovery from substance use disorders – may soon head up the U.S. Department of Health and Human Services. His opinions on methadone and buprenorphine are hard to pin down, he advocates for “wellness farms” for people with behavioral health conditions, and he’s a vocal proponent of Alcoholics Anonymous, an abstinence-based approach to SUD treatment.
Research has found that abstinence-based approaches are deadlier for patients with OUD than no treatment at all. If the person in charge of funding for many SUD and opioid-related grants does not believe in evidence-based treatment, there may be trickle-down impacts on patients to SUD providers in 2025 and beyond.
