Private equity ownership of methadone clinics has expanded across the United States without increasing the overall supply of treatment, research has found, as patients in rural areas continue to face long journeys and strict attendance rules.
More than a third of the country’s opioid treatment providers are now affiliated with private equity firms, with such ownership accounting for more than half of providers in 19 states and the District of Columbia.
But researchers found that private equity acquisitions generally did not lead to new clinics being built or to more methadone being dispensed. In counties where firms bought into the market, a single company typically controlled 67% of local methadone treatment within two years, and more than a quarter of those counties had just one private equity-controlled provider.
The findings have intensified scrutiny of the role of private investors in addiction treatment, while Congress considers legislation that would allow ordinary doctors to prescribe methadone and pharmacies to dispense it.
For Amber Titus, who lives with her husband and two young children in Bisbee Junction, Arizona, access to treatment involves a 45-minute drive three times a week to a clinic in Sierra Vista.
The 38-year-old began taking methadone in early 2025. The clinic opens at 4.30am on weekdays but closes before midday, meaning she must collect her dose and reach work in Bisbee before her 9am shift.
She said arriving 10 or 15 minutes late could mean missing a dose, even when the clinic remained open. After the family car was destroyed in a crash in August, transport arranged through Medicaid arrived late each day, and Titus missed her medication for an entire week.
“It’s been a godsend,” she said of methadone.
Methadone is one of the most effective medicines for opioid use disorder, reducing the risk of fatal overdose by about half. Yet only 22% of people with the disorder receive it, while federal estimates indicate that more than 120 people a day died from opioid overdoses in the US in 2025.
Private equity’s growing share of methadone treatment
Methadone has been dispensed for more than five decades through specialised, government-approved opioid treatment programmes rather than ordinary doctors or pharmacies. Many patients are required to attend in person every day and take their dose under observation, with limits on how much medicine they can take home.
Only 19% of people receiving take-home methadone were given at least three days’ supply, according to the research. In rural communities, average one-way journeys to clinics approach 50 minutes.
Those rules create a market with captive demand, as clinics licensed to provide methadone may be the only treatment option available in a region. Private equity firms have increasingly used a strategy of buying a large clinic and then acquiring smaller providers nearby.
Research by Yashaswini Singh, a Brown University health economist, and colleagues from the University of Pittsburgh and RAND examined the results of those acquisitions. It found that private equity ownership increased market concentration without producing more methadone capacity.
As of October 2026, 1,572 methadone clinics were registered with the US Centers for Medicare and Medicaid Services. Private equity-affiliated providers accounted for 35% of opioid treatment providers nationally.
In Arizona, private equity-backed Community Medical Services owns the Sierra Vista clinic attended by Titus. The company has 79 clinics in 14 states, including five in prisons and three mobile units, compared with 14 clinics in four states before private equity investment.
Nick Stavros, the company’s chief executive, said most of its recent expansion had come from opening new sites rather than acquisitions, with 49 clinics established in that way. However, no new clinic had been built in Montana, where CMS owns all four methadone clinics.
Stavros said constructing a clinic cost about US$2.5 million, more than many rural areas could support. He also said private investment had helped keep clinics operating in Montana and North Dakota after an investor advised that they should be closed as unprofitable.
Supporters of private equity ownership argue that large companies can provide the administrative resources needed to accept Medicare and Medicaid. One study found that clinics became significantly more likely to accept the two public insurance programmes after acquisition.
However, evidence on whether patients remain in treatment is less positive. At private equity-acquired facilities providing buprenorphine, a related medicine, patient numbers rose by about 22%, while the proportion remaining on treatment continuously for 180 days fell by nearly eight percentage points.
Congress weighs wider access to methadone
The Modernizing Opioid Treatment Access Act 2.0 would allow addiction specialists and other approved doctors to prescribe methadone, while permitting pharmacies to dispense it. The legislation is being considered by the House Energy and Commerce and Judiciary committees, although no date has been set for the next stage.
An earlier version of the bill was introduced in 2023 but did not reach a vote. The current congressional term ends in January 2027.
Patient advocacy organisations and medical societies support the proposal. The American Association for the Treatment of Opioid Dependence, a trade group representing methadone clinics, is the main organised opponent, arguing that wider prescribing and pharmacy dispensing could increase diversion and overdose risks.
Mark Parrino, the group’s president, said it objected to giving the US Health and Human Services secretary authority to decide which additional practitioners could prescribe methadone. He also raised concerns about allowing the medicine to be supplied in dispersible tablet form as well as liquid.
Parrino said tablets had been involved in a rise in methadone-related deaths that began around 1999. Federal health authorities and a Food and Drug Administration advisory, however, attributed those deaths to methadone prescribed for pain rather than addiction treatment.
Stavros said he did not view the legislation as a threat to CMS’s business model, but warned that removing regulation too quickly could allow poor providers to increase overdose risks and fuel stigma around methadone.
“We need to find ways to increase access,” he said, adding that he would support “a slow, gradual transition that led to pharmacy prescribing”.
Dr Melody Glenn, an addiction and emergency medicine specialist at the University of Arizona, supports the bill and said the restrictions on lifesaving medicines should be removed.
“They don’t have to die,” she said.
Calls for greater scrutiny of clinic ownership
The research has also prompted calls for greater transparency over who owns addiction treatment providers. Private equity firms are not subject to the same disclosure requirements as publicly traded companies, making it harder for regulators, researchers and patients to identify controlling interests.
Indiana, California and Maine have enacted or proposed measures requiring private equity and management-company ownership to be disclosed as a condition of billing Medicare or Medicaid. Vermont passed similar legislation this year.
Researchers have also called for the threshold for reporting healthcare acquisitions to be lowered. Federal antitrust authorities treat control of 30% or more of a local market as a warning sign, yet private equity ownership of methadone services typically reached 67% within two years of a firm’s first purchase in a county.
Many acquisitions escape scrutiny because they are completed through a series of smaller deals rather than one large merger. The federal reporting threshold applies to transactions worth more than about US$134 million, while some states have proposed lowering it to roughly US$10 million for healthcare acquisitions.
The US continues to face a severe opioid crisis. In 2023, about 80% of more than 100,000 drug overdose deaths involved an opioid. In 2024, nearly 80,000 people died from drug overdoses, with more than 54,000 deaths involving opioids.
For Titus, the challenge is not whether treatment works but whether it can be reached consistently. “Addiction isn’t a choice,” she said. “It’s a learning curve and eventually … you get tired of it and you want help.”
