Companies failed to respond to Senators’ questions

Letters Text (PDF) | OTP Responses (PDF)

Washington (December 12, 2024) - Senator Edward J. Markey (D-Mass.), Chair of the Health, Education, Labor, and Pensions Subcommittee on Primary Health and Retirement Security, and Senator Mike Braun (R-Ind.) today wrote to BayMark Health Services, Behavioral Health Group, Crossroads Treatment Centers, New Season, and Western Pacific Med Corp, pushing for their answers on the role of private equity investment in their opioid treatment programs (OTPs) and how that is impacting access to methadone for opioid use disorder (OUD). These letters are being released at the same time as the OTPs’ responses to the senators, following their initial query on this topic, to which the OTPs failed to answer their questions on private equity investments.

In their letters to the companies, the senators reiterate their questions and ask for answers by January 10, 2025, including:

1. Please provide a comprehensive overview of any current or previous private equity investment in your OTP, including the date of the investment, the geographic location(s) of the investment, the name(s) of the private equity firm(s) involved, and a summary of the non-confidential terms and conditions of the investment. Please also provide any term sheet. 
2. Since any private equity investment, has there been any involvement by the PE firm(s) in any decisions regarding clinical practices? If so, please describe that involvement. 
3. 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? If so, please describe them. 
4. Has any private equity investment influenced patient education and counseling regarding methadone usage, potential side effects, and associated risks? If so, how? 
5. Please provide data 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. Have there been any notable improvements or challenges in patient outcomes linked to methadone treatment since the involvement of private equity? 

Earlier this week, Senators Markey and Braun called for answers from private equity firms FLL Partners, Two Sigma Impact, Revelstroke Capital Partners, Warwick Capital Partners, Linden Capital Partners, Waud Capital Partners, Webster Equity Partners, Vistria, and BPEA Private Equity about their investments into opioid treatment programs (OTPs) and the role that private equity plays in access to, and availability of, medication for opioid use disorder, especially methadone.

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. Now, the majority (65%) of clinics are for-profit run, as opposed to 20 years ago when most were government or nonprofit run. In 21 states, at least 50% of all methadone clinics are owned either by private equity firms or by Acadia Healthcare. In Louisiana, Nebraska, New Hampshire, and Montana, 100% of all clinics are owned either by Acadia or by private equity firms.

Several 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. Senator Markey’s Modernizing Opioid Treatment Access Act (MOTAA), of which Senator Braun is a cosponsor, 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.  

Methadone is an evidence-based medication for opioid use disorder. Research has demonstrated that methadone can be more effective than buprenorphine for retaining patients in treatment. However, methadone for opioid use disorder – and not for chronic pain – is restricted to opioid treatment programs (OTPs). This structure was created under the Nixon administration when the United States experienced roughly 7,000 overdoses annually. Currently, it is federally illegal for the approximately 7,000 physicians trained in addiction medicine and addiction psychiatry in the United States to prescribe methadone to their patients for opioid use disorder.

OTPs, while an essential part of the care spectrum, cannot meet demands for care. Currently, the OTP structure requires patients travel long distances or face significant stigma when receiving care, even when there are hospitals, physician practices, or health centers within a closer distance with providers trained to provide addiction care and able to provide ancillary care. In fact, some patients are forced to leave the hospital to travel multiple hours to obtain methadone.

The Modernizing Opioid Treatment Access Act would carefully expand methadone prescribing for opioid use disorder by allowing board certified addiction medicine and addiction psychiatry physicians to prescribe methadone for opioid use disorder. Prescribing methadone for opioid use disorder outside of an OTP setting is not new; Australia, Great Britain, and Canada allow for methadone prescription in primary care settings. Pilots demonstrating the efficacy and safety of expanding methadone beyond OTPs have also been demonstrated in Maryland, North Carolina, New Mexico, and more.

Additionally, evidence acquired during the COVID-19 pandemic with greater flexibility for OTPs to provide take-home doses demonstrated that expanded access to methadone is safe. Data on overdose deaths indicate no significant increase in methadone overdoses, and Dr. Yngvild Olsen of the Substance Abuse and Mental Health Services Administration noted that the take-home flexibilities did not increase the rate of methadone deaths. When methadone is diverted, it is often for the purpose of self-medication for OUD treatment.

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.

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