Private equity is buying up more methadone clinics. Access to the lifesaving drug isn’t getting easier.

Private equity firms have acquired a growing share of the U.S. methadone clinic market, raising questions about whether capital investment has improved patient access to the medication. According to the article, which was written by a Brown University healthcare economist, PE firms own 35% of opioid treatment providers nationally, and more than half of providers in 19 states and the District of Columbia have PE owners. Methadone is largely dispensed only through federally licensed opioid treatment programs, creating what the author describes as a government-created monopoly in which operators can set terms for patients who must often visit clinics daily.

Research cited in the article found that acquisitions have not increased capacity. Earlier work examining 2011 to 2019 deals found that PE firms typically controlled 67% of local methadone treatment within two years of entry, and that methadone shipments and opioid-related deaths were unchanged during the study period. The author characterizes the pattern as firms buying existing capacity rather than building new capacity. For buprenorphine, one study found patient volume at PE-acquired facilities rose about 22% after acquisition, while the share of patients remaining on treatment for 180 days fell by nearly 8 percentage points. Proponents note that one study found acquired clinics became significantly more likely to accept Medicare and Medicaid.

The article profiles Community Medical Services (CMS), which operates 79 clinics in 14 states according to CEO Nick Stavros, up from 14 clinics in four states before PE investment. Stavros said 49 of those clinics came from new sites rather than acquisitions, and that building a new clinic costs about $2.5 million. The article also notes that CMS owns the Sierra Vista, Arizona clinic serving patient Amber Titus, whose experience with transportation delays illustrates access barriers in rural areas.

Policy debate centers on the Modernizing Opioid Treatment Access Act 2.0, which would permit regular doctors to prescribe methadone and pharmacies to dispense it. The bill is under consideration by the House Energy and Commerce and Judiciary committees, with no markup scheduled. Rep. Donald Norcross, D-N.J., is a sponsor. The American Association for the Treatment of Opioid Dependence (AATOD), a trade group representing methadone clinics, opposes the bill, citing concerns about diversion and overdose risk, according to a STAT investigation and AATOD president Mark Parrino. Stavros, AATOD's Arizona representative, said he would support a gradual transition to pharmacy prescribing. Dr. Melody Glenn of the University of Arizona supports the bill but says it should go further.