Letter Text (PDF)

Washington (December 10, 2024) - Senator Edward J. Markey (D-Mass.), chair of the Health, Education, Labor, and Pensions Subcommittee on Primary Health and Retirement Security, along with Senator Mike Braun (R-Ind.), today called for answers from FLL Partners, Two Sigma Impact, Revelstroke Capital Partners, Warwick Capital Partners, Linden Capital Partners, Waud Capital Partners, Webster Equity Partners, Vistra New York, 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.

Methadone is a highly effective, proven medication for stabilizing patients with opioid use disorder and helping them stay in recovery, but few people in need of methadone treatment receive it due to restrictions on access under federal law. Senator Markey’s Modernizing Opioid Treatment Access Act (MOTAA), of which Senator Braun is a cosponsor, would modernize the outdated rules governing methadone, empowering board-certified addiction psychiatry and addiction medicine physicians registered with the Drug Enforcement Administration to prescribe methadone for opioid use disorder to patients, and allowing U.S. pharmacies to dispense it. Yet, many for-profit and private equity-owned and affiliated OTPs seek to continue to require patients to receive treatment at OTPs and are actively opposing the legislation. 

In the letters, the lawmakers write, “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.”

Senators Markey and Braun asked the companies to respond to questions by January 10, 2025, including:

• Please provide a comprehensive overview of any investment by your private equity firm in any OTP, including the name of the OTP, the date of the investment, the geographic location(s) of the investment, and a summary of the non-confidential terms and conditions of the investment. Please also provide any term sheet. 

• If your private equity firm has invested in any OTP, what specific objectives or goals were outlined in the agreement between your firm and the OTP? How have these objectives been tracked and measured over time? 

• What is the total amount of capital that your private equity firm invested in any OTP? 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? 

• Please provide data on patient outcomes specifically related to methadone treatment, both pre- and post- any 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 your private equity firm? 
• How has any investment affected the OTP’s compliance with state and federal regulations governing the use of methadone in opioid treatment programs? Are there any specific challenges or successes related to regulatory compliance that can be attributed to your private equity investment? 

Senator Markey previously led his bipartisan 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.

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. 

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