Washington (March 13, 2024) –  Senator Edward J. Markey (D-Mass.), chair of the Senate Health, Education, Labor, and Pensions Subcommittee on Primary Health and Retirement Security, led his colleagues in letters to Acadia Healthcare, BayMark Health Services, Behavioral Health Group, Carolina Treatment Centers, Crossroads Treatment Centers, New Season, and Western Pacific Med Corp to investigate the role of private equity investment in opioid treatment programs (OTPs) and how that is impacting access to methadone for opioid use disorder (OUD). In their letters, the senators ask the private equity companies to provide a comprehensive overview of any private equity investment in an OTP. 

Methadone is a gold standard treatment for OUD. According to the National Institute on Drug Abuse, a large number of studies have supported that methadone is an effective treatment at reducing opioid use and reduces the likelihood from dying from an opioid overdose by 50 percent or more. However, many individuals who need methadone treatment do not receive it due to stringent restrictions placed on access. Methadone for OUD is only available through OTPs. For some patients, accessing an OTP is impossible due to long travel distances or the stigma associated.  

In recent years, private equity investment in OTPs has grown significantly. In 2000, a majority of clinics were non-profit. By 2017, 60 percent of clinics were for-profit. Several of these for-profit clinics are opposed to federal legislation making its way through Congress to liberalize and reform how patients suffering from OUD can access methadone, despite evidence demonstrating its effectiveness in reducing overdose deaths. Led by Senator Markey, the Modernizing Opioid Treatment Access Act (MOTAA) would allow board certified addiction medicine and addiction psychiatry physicians, who are registered with the Drug Enforcement Administration (DEA), to prescribe methadone that could be picked up at a pharmacy.   

In the letters, the lawmakers wrote: “We are concerned that there is incompatibility manifesting itself in private-equity-backed OTPs seeking to maintain their monopoly on methadone access, not because it is good for the patient, but because it is good for the bottom line. Any interference with policies that would save lives for the sake of profit is unacceptable.” 

Cosigners in the Senate include Senators Mike Braun (R-Ind.), Maggie Hassan (D-N.H.), and Elizabeth Warren (D-Mass.). Cosigners in the House include Representatives Donald Norcoss (NJ-01) and Don Bacon (NE-02). 

To better understand how private-equity investment in OTPs impacts access to and the use of methadone for OUD, the senators request written answers of the private equity companies to questions by April 12 that include: 

1. If there is any private equity investment in your OTP, what specific objectives or goals were outlined in the agreement between the OTP and the private equity firm(s)? How have these objectives been tracked and measured over time? 
2. What is the total amount of capital that the private equity firm(s) invested in your OTP, if any? How has this investment been allocated within the OTP, and what key areas or projects have received funding as a result of the private equity investment?  
3. Has your OTP made any modifications to the criteria or guidelines for prescribing or dispensing methadone since any private equity investment?  
4. Since any private equity investment, has there been any involvement by the PE firm(s) in any decisions regarding clinical practices?  
5. Since any private equity investment, have there been any updates or enhancements to the training programs provided to OTP staff involved in methadone prescribing and dispensing?  
6. Has any private equity investment influenced patient education and counseling regarding methadone usage, potential side effects, and associated risks?  
7. What data is collected on patient outcomes specifically related to methadone treatment, both pre- and post- any private equity investment, including data on key performance indicators related to patient success rates, relapse rates, and overall satisfaction?  
8. How has any private equity investment affected the OTP’s compliance with state and federal regulations governing the use of methadone in opioid treatment programs?  

In March 2023, Senators Markey and Rand Paul (R-Ky.), along with Representatives Norcross and Bacon, introduced their bipartisan and bicameral MOTAA, which would represent the first major reform to methadone in half a century and is supported by hundreds of clinicians and medical organizations. In December 2023, MOTAA passed the Senate Health, Education, Labor, and Pensions (HELP) Committee. In December 2022, Senator Markey secured his bipartisan Opioid Treatment Access Act (OTAA)—legislation that reduces wait times for patients qualifying for methadone medication treatment and expands access to methadone clinics—into the end-of-year omnibus spending package. That same month, Senator Markey also applauded proposed changes by the Department of Health and Human Services to remove barriers to OUD treatment, such as allowing people to take home doses of methadone medication, which are key provisions included in the OTAA.