States Are Increasing Access to Methadone Clinics

As policymakers work to maintain the downward trend in opioid overdose deaths, state officials have turned their attention to methadone treatment and ways of making this lifesaving medication more accessible.

Generally, opioid treatment programs (OTPs) are the only setting where people with opioid use disorder (OUD) can receive methadone, which is typically administered daily. Federal and state rules governing OTPs are more burdensome than those for other healthcare facilities and have made it difficult for these programs to operate and for patients to access services. But in 2024, federal regulatory changes eased certain restrictions, and state regulators and lawmakers have been working to align their policies with federal updates that promote patient-centered care.

In 2024, the Substance Abuse and Mental Health Services Administration (SAMHSA) made two key changes to federal regulations to extend treatment flexibilities offered during the COVID-19 public health emergency: easing eligibility to receive take-home doses of methadone and initiating treatment via telehealth.

These changes significantly lessen burdens on patients who otherwise would have to attend treatment programs daily to receive their medication. Studies show that the flexibilities positively affect patients’ experience without significantly increasing methadone diversion—which can occur when someone takes a drug that hasn’t been dispensed for them—or methadone-related overdose deaths in states that eased take-home dose limitations. Most states opted in to SAMHSA’s exemption guidance during the pandemic and are now formally adopting those changes in regulations, eliminating barriers to treatment and moving toward more evidence-based practice.

Before the new federal rules governing OTPs took effect, research by The Pew Charitable Trusts found that many state policies regarding methadone treatment were more restrictive than the federal government’s. The additional layers of regulation imposed by states limit access to care, including where and when OTPs can open; the types of providers who can dispense methadone; and how patients receive care, with strict eligibility guidelines for take-home doses and mandatory termination of treatment for minor infractions of program rules. For example, New Jersey was one of many states that required OTP patients to adhere to a set counseling schedule as a condition of receiving treatment. In regulatory revisions made in February 2026, the state removed this requirement and now explicitly says that patients may not be discharged from treatment solely for declining to participate in counseling sessions. This change is in line with clinical guidelines and promotes individualized care plans and retention in treatment.

Multiple states added or changed language in their rules to simplify the operation of medication units, which are stationary or mobile OTP satellites typically used to expand access to methadone treatment, particularly in rural areas that lack convenient OTPs. SAMHSA’s revised rule clarified that any services provided in an OTP may also be provided by medication units, broadening the scope of these sites and the opportunity to reach new patients with comprehensive care.

In rules finalized in June 2026, Michigan removed restrictions on mobile units so treatment programs can meet people where they are. And New Mexico and New Jersey added sections to their regulations explicitly permitting OTPs to operate medication units in new settings, such as pharmacies.

States are also eliminating restrictions that prevent new OTPs from opening. As of June 2021, 19 states and Washington, D.C., required some form of legal document demonstrating the need for a new facility before an OTP could open. In large part because of this barrier to entry, only one new OTP had opened in Louisiana since 2015, despite increases in opioid overdose deaths during that time. To address the lack of OTPs, Louisiana enacted a law in May 2026 removing the review requirement. That same month, New Mexico also removed from regulation the needs assessment requirement.

More states are expected to take action on this issue soon. The Wisconsin Department of Health Services has signaled forthcoming changes to its OTP regulations so that they are more consistent with federal rules.

To build on this progress, state agency officials can reference Pew’s state OTP regulatory research to begin or continue identifying inconsistencies with federal regulations and amending their rules. Some barriers to OTP operation may continue to exist in statute—such as in New Mexico, where OTPs are required to be licensed as pharmacies and have their own pharmacist on staff—and will require partnership with state legislators to resolve.

States aligning their OTP regulations with the new SAMHSA rules are removing other restrictive provisions, such as the requirement that patients have a one-year history of OUD before entering treatment and arbitrary caps on methadone doses that providers may dispense. Together, these updates represent meaningful movement away from onerous restrictions that make it harder for programs to offer quality care and toward expanded access to patient-centered methadone treatment that better meets the needs of people with OUD.

Andrew Whitacre works on The Pew Charitable Trusts’ substance use prevention and treatment initiative.