One private equity–backed company owns every methadone clinic in Montana

An article republished by Fortune, originally written for The Conversation by a Brown University healthcare economist, examines how private equity ownership has concentrated the U.S. methadone treatment market. The piece states that Community Medical Services (CMS) owns every methadone clinic in Montana, four in total, and also owns three of North Dakota's four methadone clinics and the Sierra Vista, Arizona clinic that serves patients in the border community of Bisbee Junction. The article uses the experience of a patient, Amber Titus, who drives roughly 30 miles to the clinic, to illustrate the access burden created by the regulated model.

Methadone is governed by a decades-old rule that restricts dispensing to government-approved opioid treatment programs. The author describes this as a government-created monopoly, in which clinics can control access for captive patients who must attend in person, often daily. Citing the author's research, co-written with researchers from the University of Pittsburgh and RAND, the article reports that private equity firms have acquired more than one-third of U.S. methadone clinics but have not expanded methadone availability or the construction of new facilities. Earlier work covering 2011 to 2019 found that a private equity firm typically controlled 67% of a county's methadone market within two years of entry, and in more than a quarter of counties a single firm held the entire market. Methadone shipments and opioid-related deaths were unchanged over the study period.

CMS CEO Nick Stavros told the authors that the company had 14 clinics in four states before private equity investment and now operates 79 clinics in 14 states, including five prison clinics and three mobile units. He said 49 of the recent additions came from new sites rather than acquisitions. He also said no expansion had occurred in Montana, citing a cost of about $2.5 million to build a new clinic. In 2018, a prospective investor had advised closing CMS's Montana and North Dakota clinics as unprofitable, and Stavros instead partnered with a different private equity firm to keep them open.

The article acknowledges an offsetting benefit: one study found clinics were significantly more likely to accept Medicare and Medicaid after acquisition. However, a study of buprenorphine found patient volume at private equity-acquired facilities rose about 22% after acquisition, while the share of patients continuously retained for 180 days fell by nearly 8 percentage points. Comparable methadone data was not available.

The policy debate centers on the Modernizing Opioid Treatment Access Act 2.0 (MOTAA 2.0), which would permit regular doctors to prescribe methadone and pharmacies to dispense it. The original bill, introduced in 2023, did not reach a floor vote. MOTAA 2.0 is under consideration by the Energy and Commerce and Judiciary committees, which have not scheduled a markup. The article notes that the American Association for the Treatment of Opioid Dependence (AATOD), a trade group for methadone clinics, opposes the bill over concerns about diversion, overdose risk, and dispersible tablets, and that Stavros, who serves as AATOD's Arizona representative, does not see the bill as a threat to CMS's business model. Supporters include Rep. Donald Norcross, D-N.J., and Dr. Melody Glenn of the University of Arizona, who said the legislation should go further.