Q: What role does methadone play in addressing OUD and overdose deaths?

Yngvild Olsen: Decades and decades of evidence—research studies and large population-based studies—have demonstrated that methadone reduces the risk of opioid-related overdose by over 50%. It has a very dramatic impact on the risk of people dying from overdose. Matthew Strait: From the perspective of my predecessor agency, the DEA, methadone clearly has the longest established record of being an effective treatment for patients with OUD.

Q: What is methadone diversion? What does it look like in practice?

YO: There's not really a medical term for diversion. But we look at patient behavior—that may include trading, selling, or sharing a medication at a certain dose that has been prescribed or dispensed to you—and then learn that the patient is not taking the methadone. And diversion happens not just with methadone, but also with numerous prescription medications—including antibiotics, ibuprofen, and more—that people share, trade, and sometimes even sell. When these behaviors happen, not only does the patient not have the benefit of getting the right dose of medication for their particular condition—in this case, OUD—but it can potentially harm the person who receives and takes that medication, intentionally or unintentionally.

Q: Why would people divert medication, or use diverted medication?

YO: There have been a few studies on this. One of the big factors in taking methadone or buprenorphine that has not been provided to an individual has been trouble accessing treatment—it’s too far away, or it’s unaffordable, or the requirements of the program may be too numerous. So people primarily used diverted methadone to self-treat their opioid withdrawal because they weren't feeling well. Anecdotally, we’ve frequently seen people undertreated with inadequate doses of methadone, particularly to address the withdrawal they're experiencing from fentanyl. So they may seek out additional medication to therapeutically treat themselves.

Q: Does take-home medication increase diversion?

MS: Because of flexibilities that started during COVID, we now have six years of experience in terms of whether take-home methadone has increased diversion. And from a 20,000-foot viewpoint, I would say it has not. And that means actual diversion, not the risk of diversion. Risk is one thing, but actual diversion doesn’t bear itself out in the evidence. In a 2022 DEA report, the most recent one available on the DEA Diversion Control website, methadone is not even in the top 25 controlled substances reported by federal, state, or local law enforcement. I hope that shows law enforcement isn’t widely facing misuse or diversion of methadone. YO: COVID procedures provided that natural experiment we needed to understand the potential impact of broadening access to methadone, since diversion itself is hard to measure. So researchers looked at methadone-related mortality, which is what we as providers were really worried about. From 2020 through 2024, methadone-related overdose mortality actually declined according to a number of studies. So I think it's important to recognize that, with this large expansion of access to medication take-homes, we did not see the negative impact on methadone-related mortality that people were worried about for a long time.

Q: Dr. Olsen, as a clinician, what might lead you to suspect that someone is diverting methadone?

YO: Federal regulations require that OTPs have a diversion control plan, focusing not only on patients but also internal diversion, which happens if clinic staff illegally take inventory. There needs to be close accounting of all methadone and how much is coming in and going out. But with respect to their patients, there are a few things that may tip off a clinician. First off, there is a federal requirement for drug testing for people taking methadone. If you don't find evidence someone is taking their medication, that’s a flag. Occasionally somebody will bring in an empty medication bottle they found out on the street and there's another patient's name on it. Or a patient might come in for their medication early and say it’s been lost or stolen.

Q: How would the OTP handle it?

YO: There are several ways to respond. Talk to the patient and say we're worried about you and how you're managing your medication. SAMHSA also now requires documented education for patients to make sure those getting take-homes know how to safely and securely transport and store the medication so that it can't get accessed by kids, pets, and other people who live in the house or are visiting. If staff have concerns, we can have people come in every day and get their medication administered to them, observed. But from my perspective, if you're not taking your medication, we need to understand why. And if the person is really not taking their medication—I’ve had it happen once, maybe twice in my 30-year career—we have to ask, “Do you really want to be here?” Then sometimes we will discharge people.

Q: How much do diversion concerns, versus actual evidence, shape methadone policy today?

YO: While I can’t speak for SAMHSA at the moment, when I was there, it was the data that came out after COVID that convinced SAMHSA that it would be safe and effective to continue those flexibilities and access to methadone take-homes. That was a big deal. Because that was one of the biggest barriers that patients and providers and states had pointed to for decades as to why methadone was being so underused for OUD treatment. And it contributed to a lot of community conflicts because many people would wait every single day in long lines outside of OTPs to get their medication. Despite the evidence and positive outcomes, we know some lawmakers still have outsize concerns about diversion. So it’s important to keep educating people who legislate and regulate this issue. MS: Methadone was being prescribed [for pain] in the 2000s, resulting in a surge of overdose deaths, and I think that really influenced the way law enforcement thought about methadone for the next decade and a half. But that’s not the issue we see today. In 2006, nobody was talking about an opioid epidemic. In 2020, law enforcement was very concerned about take-home doses of methadone and how those might result in overdose deaths. The good news is that [the U.S. Department of Health and Human Services] provided data and evidence to suggest that take-home methadone really wasn't translating into a public health crisis.

Q: Should these concerns inform policy at all?

YO: There's a risk-benefit balance, which is what practitioners consider in medicine all the time, because there's also a risk of not providing people with medication that they find beneficial to treat their OUD. We know if people don't get access to that, then they will use illicitly manufactured fentanyl or go back to the streets to self-treat. As a practitioner, you work with patients to reduce those risks. MS: SAMHSA's data suggests there's an estimated 9.4 million adults age 18 or older who met the criteria for needing OUD treatment. Of those, in 2022, only 5.2 million received some form of treatment, meaning that there were 45% of adults who needed treatment and didn't get any at all. Law enforcement is obviously concerned about controlled substances being misused, diverted, and so on. But when you also have this gap in treatment, it becomes a balancing act of which concern takes precedent. When I was in a leadership capacity, we leaned more heavily on the interests of this greater public health need. How do you do that in a way that effectively addresses law enforcement concerns? By building in the kinds of guardrails that Dr. Olsen talked about and putting it in the clinician's hands to care for and monitor their patients.

Q: Is there anything that you wish more people understood about this issue?

YO: Methadone is a medication. Like any other, it has both therapeutic benefits and risks and should be seen as healthcare and treatment for a life-threatening condition because it has lifesaving properties. I think that's something a lot of people don't understand because they see it as a problem and not as part of the solution. MS: A decade ago there were only about 1,400 OTPs in the country, and there was a big call to action to have more. Today, we stand at about 2,200 OTPs nationwide, and that success should be celebrated. But 4 out of every 5 counties in the United States still do not have an OTP. That means patients in need typically have to travel long distances for treatment, potentially daily until they can be stabilized and hopefully get on take-home dosing. So we need to constantly look for new ways to get access to patients and meet them where they're at, especially in rural areas, because that continues to be a big problem.

Take-Home Methadone Has Not Increased Medication Diversion

Two experts discuss the data behind a still-stigmatized treatment for opioid use disorder

Article August 7, 2026

Decades of evidence demonstrate the safety and effectiveness of methadone for treating opioid use disorder (OUD), significantly reducing overdose and death. Yet the medication has been available only in communities at highly regulated opioid treatment programs (OTPs) since the 1970s, in part because of misconceptions and stigma. In 2024, federal government regulations loosened restrictions on methadone treatment at OTPs, but not all states followed, and of those that did, many adopted only some of the changes. Specifically, while 85% of states adopted more than half of the revised rules, only 37% adopted all of them as of February 2025. This mismatch between state and federal policies contributes to a treatment gap for people addicted to opioids.

Concerns about methadone diversion—which may occur when someone takes a drug that hasn’t been dispensed for them—have been a barrier to patient-centered, evidence-based policy. To better understand this issue, Pew spoke with Dr. Yngvild Olsen and Matthew Strait. Olsen is a practicing addiction medicine physician at an OTP and provides strategic counsel on substance use disorders (SUDs), particularly OUD, integrating SUD treatment services into primary care and Medicaid. Most recently, Olsen directed the Center for Substance Abuse Treatment at the Substance Abuse and Mental Health Services Administration (SAMHSA), leading efforts to expand access to care and promote evidence-based SUD treatment practices.

Strait worked for more than two decades at the Drug Enforcement Administration (DEA), most recently as deputy assistant administrator for the Diversion Control Division. He is now owner and principal adviser at Controlled Substance Strategies LLC, which partners with pharmaceutical manufacturers and distributors, pharmacies, healthcare organizations, and prescribers to advise on regulatory strategy, policy interpretation, advocacy, and more.

This interview has been edited for length and clarity.

Q: What role does methadone play in addressing OUD and overdose deaths?

Yngvild Olsen: Decades and decades of evidence—research studies and large population-based studies—have demonstrated that methadone reduces the risk of opioid-related overdose by over 50%. It has a very dramatic impact on the risk of people dying from overdose.

Matthew Strait: From the perspective of my predecessor agency, the DEA, methadone clearly has the longest established record of being an effective treatment for patients with OUD.
Q: What is methadone diversion? What does it look like in practice?

YO: There's not really a medical term for diversion. But we look at patient behavior—that may include trading, selling, or sharing a medication at a certain dose that has been prescribed or dispensed to you—and then learn that the patient is not taking the methadone. And diversion happens not just with methadone, but also with numerous prescription medications—including antibiotics, ibuprofen, and more—that people share, trade, and sometimes even sell.

When these behaviors happen, not only does the patient not have the benefit of getting the right dose of medication for their particular condition—in this case, OUD—but it can potentially harm the person who receives and takes that medication, intentionally or unintentionally.
Q: Why would people divert medication, or use diverted medication?

YO: There have been a few studies on this. One of the big factors in taking methadone or buprenorphine that has not been provided to an individual has been trouble accessing treatment—it’s too far away, or it’s unaffordable, or the requirements of the program may be too numerous. So people primarily used diverted methadone to self-treat their opioid withdrawal because they weren't feeling well.

Anecdotally, we’ve frequently seen people undertreated with inadequate doses of methadone, particularly to address the withdrawal they're experiencing from fentanyl. So they may seek out additional medication to therapeutically treat themselves.
Q: Does take-home medication increase diversion?

MS: Because of flexibilities that started during COVID, we now have six years of experience in terms of whether take-home methadone has increased diversion. And from a 20,000-foot viewpoint, I would say it has not. And that means actual diversion, not the risk of diversion. Risk is one thing, but actual diversion doesn’t bear itself out in the evidence.

In a 2022 DEA report, the most recent one available on the DEA Diversion Control website, methadone is not even in the top 25 controlled substances reported by federal, state, or local law enforcement. I hope that shows law enforcement isn’t widely facing misuse or diversion of methadone.

YO: COVID procedures provided that natural experiment we needed to understand the potential impact of broadening access to methadone, since diversion itself is hard to measure. So researchers looked at methadone-related mortality, which is what we as providers were really worried about.

From 2020 through 2024, methadone-related overdose mortality actually declined according to a number of studies. So I think it's important to recognize that, with this large expansion of access to medication take-homes, we did not see the negative impact on methadone-related mortality that people were worried about for a long time.
Q: Dr. Olsen, as a clinician, what might lead you to suspect that someone is diverting methadone?

YO: Federal regulations require that OTPs have a diversion control plan, focusing not only on patients but also internal diversion, which happens if clinic staff illegally take inventory. There needs to be close accounting of all methadone and how much is coming in and going out. But with respect to their patients, there are a few things that may tip off a clinician.

First off, there is a federal requirement for drug testing for people taking methadone. If you don't find evidence someone is taking their medication, that’s a flag.

Occasionally somebody will bring in an empty medication bottle they found out on the street and there's another patient's name on it. Or a patient might come in for their medication early and say it’s been lost or stolen.
Q: How would the OTP handle it?

YO: There are several ways to respond. Talk to the patient and say we're worried about you and how you're managing your medication. SAMHSA also now requires documented education for patients to make sure those getting take-homes know how to safely and securely transport and store the medication so that it can't get accessed by kids, pets, and other people who live in the house or are visiting.

If staff have concerns, we can have people come in every day and get their medication administered to them, observed. But from my perspective, if you're not taking your medication, we need to understand why. And if the person is really not taking their medication—I’ve had it happen once, maybe twice in my 30-year career—we have to ask, “Do you really want to be here?” Then sometimes we will discharge people.
Q: How much do diversion concerns, versus actual evidence, shape methadone policy today?

YO: While I can’t speak for SAMHSA at the moment, when I was there, it was the data that came out after COVID that convinced SAMHSA that it would be safe and effective to continue those flexibilities and access to methadone take-homes. That was a big deal. Because that was one of the biggest barriers that patients and providers and states had pointed to for decades as to why methadone was being so underused for OUD treatment. And it contributed to a lot of community conflicts because many people would wait every single day in long lines outside of OTPs to get their medication.

Despite the evidence and positive outcomes, we know some lawmakers still have outsize concerns about diversion. So it’s important to keep educating people who legislate and regulate this issue.

MS: Methadone was being prescribed [for pain] in the 2000s, resulting in a surge of overdose deaths, and I think that really influenced the way law enforcement thought about methadone for the next decade and a half. But that’s not the issue we see today. In 2006, nobody was talking about an opioid epidemic. In 2020, law enforcement was very concerned about take-home doses of methadone and how those might result in overdose deaths. The good news is that [the U.S. Department of Health and Human Services] provided data and evidence to suggest that take-home methadone really wasn't translating into a public health crisis.
Q: Should these concerns inform policy at all?

YO: There's a risk-benefit balance, which is what practitioners consider in medicine all the time, because there's also a risk of not providing people with medication that they find beneficial to treat their OUD. We know if people don't get access to that, then they will use illicitly manufactured fentanyl or go back to the streets to self-treat. As a practitioner, you work with patients to reduce those risks.

MS: SAMHSA's data suggests there's an estimated 9.4 million adults age 18 or older who met the criteria for needing OUD treatment. Of those, in 2022, only 5.2 million received some form of treatment, meaning that there were 45% of adults who needed treatment and didn't get any at all.

Law enforcement is obviously concerned about controlled substances being misused, diverted, and so on. But when you also have this gap in treatment, it becomes a balancing act of which concern takes precedent. When I was in a leadership capacity, we leaned more heavily on the interests of this greater public health need. How do you do that in a way that effectively addresses law enforcement concerns? By building in the kinds of guardrails that Dr. Olsen talked about and putting it in the clinician's hands to care for and monitor their patients.
Q: Is there anything that you wish more people understood about this issue?

YO: Methadone is a medication. Like any other, it has both therapeutic benefits and risks and should be seen as healthcare and treatment for a life-threatening condition because it has lifesaving properties. I think that's something a lot of people don't understand because they see it as a problem and not as part of the solution.

MS: A decade ago there were only about 1,400 OTPs in the country, and there was a big call to action to have more. Today, we stand at about 2,200 OTPs nationwide, and that success should be celebrated. But 4 out of every 5 counties in the United States still do not have an OTP. That means patients in need typically have to travel long distances for treatment, potentially daily until they can be stabilized and hopefully get on take-home dosing. So we need to constantly look for new ways to get access to patients and meet them where they're at, especially in rural areas, because that continues to be a big problem.