Private Equity Owns a Third of U.S. Methadone Clinics, Access Stalls

Three times a week, Amber Titus wakes at 5 a.m. and drives 45 minutes each way from Bisbee Junction, Arizona, to a methadone clinic in Sierra Vista, her 1-year-old in a car seat behind her. The clinic opens at 4:30 a.m. and closes before midday; her shift in Bisbee starts at 9. In August the family car was totaled, and the rides Medicaid arranged arrived late every morning for a week. She missed every dose.

That routine is the backdrop to a policy argument now moving through Congress, and to a body of research summarized October 28 in The Conversation by Yashaswini Singh, a health economist at Brown University. Her finding: private equity firms have acquired more than a third of U.S. methadone clinics, and the acquisitions have not expanded methadone treatment or produced new facilities. As of October 2026, 1,572 methadone clinics are registered with the Centers for Medicare & Medicaid Services; 35% of opioid treatment providers nationally are affiliated with private equity, and in 19 states plus the District of Columbia, more than half are. The work has fed into federal scrutiny: Sen. Maggie Hassan of New Hampshire has an open investigation into three of the largest methadone clinic operators, questioning whether they oppose wider access for financial rather than clinical reasons.

Methadone cuts the risk of fatal overdose by roughly half. Only 22% of people with opioid use disorder ever receive it, and more than 120 people a day died of opioid overdose in 2025 by federal estimates.

A monopoly the government designed

Federal law has for five decades restricted methadone dispensing to opioid treatment programs, keeping it out of ordinary doctors' offices and pharmacies. Patients generally must appear in person to be observed taking the dose, with take-home supplies tightly limited and varying by state, time in treatment and clinician judgment. Nationally, only 19% of patients who received take-home methadone got three or more days' supply.

That structure behaves less like a competitive market than a franchise. Whoever owns the clinics in a region controls access to the medication for everyone within driving distance, and the drive is long: average one-way travel times in rural communities approach 50 minutes.

What the deals changed

Singh's earlier work, covering acquisitions from 2011 to 2019, found that within two years of a private equity firm buying its first clinic in a county, the firm typically controlled 67% of the local methadone treatment market. In more than a quarter of counties, one firm held all of it. The clinics did not multiply: acquisitions generally did not lead to new construction or to more people treated, and methadone shipment volumes and opioid-related death rates were unchanged over the study period.

The article describes the strategy as platform-and-add-on buying — one large clinic, then every smaller competitor nearby — a pattern that leaves each individual deal too small to notice and the cumulative result, in some regions, a single owner.

The counter-example the industry cites

Community Medical Services, known as CMS, operates all four of Montana's methadone clinics and three of North Dakota's four, including the Sierra Vista clinic where Titus doses. In 2018, a prospective investor advised closing the Montana and North Dakota sites as unprofitable; CEO Nick Stavros instead partnered with a different private equity firm to keep them open.

CMS had 14 clinics in four states before private equity investment. It now reports 79 clinics in 14 states, five of them inside prisons, plus three mobile units — and Stavros says 49 of the recent additions were built rather than bought. Montana still has four. A new clinic costs about $2.5 million, he said, more than many rural markets can support.

That is the strongest version of the industry case, and it is not nothing. Singh also concedes a real benefit in the literature: clinics became significantly more likely to accept Medicare and Medicaid after acquisition, plausibly because chains can afford billing and compliance staff that independent clinics cannot.

Where the evidence turns

Insurance acceptance is an input, not an outcome. For buprenorphine, a medication that can be prescribed far more broadly, one study found patient volume at private equity-acquired facilities rose about 22% after acquisition — while the share of patients who stayed continuously on the medication for 180 days, the national quality benchmark, fell nearly 8 percentage points. Early discontinuation is among the strongest predictors of relapse and overdose.

Comparable retention data for methadone is not available, which is itself part of the story: the federal reporting apparatus tracks claims and doses better than it tracks whether patients stay in care.

Congress has the bill, not the votes scheduled

The Modernizing Opioid Treatment Access Act 2.0 would let physicians and other qualified prescribers outside the opioid treatment program system prescribe methadone and allow pharmacies to dispense it. It sits with the House Energy and Commerce and Judiciary committees, neither of which has scheduled a markup; the current congressional term ends in January 2027.

The bill's supporters include patient advocacy organizations and medical societies. Its main organized opposition, per reporting by STAT, comes from the American Association for the Treatment of Opioid Dependence, the trade group representing clinics. AATOD president Mark Parrino told The Conversation the group objects on two grounds: the bill would let the HHS secretary decide which additional practitioners qualify, and it would permit dispersible tablets alongside liquid methadone. Tablets "were definitely" part of the methadone death increase that began around 1999, he said — a rise that the CDC and an FDA advisory attributed to methadone prescribed for pain rather than for addiction treatment.

Stavros, who is also AATOD's Arizona representative, said he does not see the bill as a threat to CMS's business but worries that removing regulation too quickly could let a few bad operators push overdose rates up and worsen stigma. "We need to find ways to increase access," he said, adding that he would support a slow, gradual transition to pharmacy dispensing.

Dr. Melody Glenn, an associate professor of addiction and emergency medicine at the University of Arizona who previously worked in a Tucson methadone clinic, supports the bill and wants it to go further. "It's time to remove the regulatory barriers to these lifesaving medications," she told The Conversation. "They don't have to die."

Two quieter levers

Ownership disclosure is advancing at the state level. Indiana, California, Maine and Vermont have enacted or proposed requirements that companies reveal private equity and management-company ownership as a condition of billing Medicare or Medicaid. Federal antitrust review is the other lever: the Justice Department and Federal Trade Commission treat 30% control of a local market as a red flag, yet the research shows chains typically reach 67% within two years — and never trigger a federal filing, because the deals are assembled piecemeal under the roughly $134 million reporting threshold. Some states have floated lowering that threshold to about $10 million for health care transactions.

Singh discloses that her work is supported in part by Arnold Ventures and that she sits on the advisory council of the Private Equity Stakeholder Project, and The Conversation notes the funding behind its accountability reporting. The financial-interest question runs in both directions here: the clinics arguing against expanded prescribing have a market share to protect, and the researcher arguing for transparency has funders with a position.

For patients, the arithmetic is less abstract. "Addiction isn't a choice," Titus said. "It's a learning curve and eventually … you get tired of it and you want help." Whether that help requires a 45-minute drive before sunrise is a regulatory choice, and one that methadone patients in most states still have no way to avoid. People looking for care can compare medication-assisted treatment options and opioid rehab programs, and the July reintroduction of the pharmacy-access bill is covered in our earlier report.