Private equity is buying up more methadone clinics

Methadone substantially reduces the risk of fatal overdose, yet only 22% of people with opioid use disorder receive it. Strict federal rules have long limited dispensing to specialized clinics, often requiring daily in-person visits. Rural patients may travel nearly an hour each way, and rigid hours and missed transportation can interrupt treatment. Amber Titus, who drives 30 miles to a clinic in Arizona, missed a week of doses when Medicaid-arranged rides repeatedly arrived late. The growing ownership of these clinics by private equity firms has not resolved such barriers.

Research on clinic acquisitions from 2011 to 2019 found that private equity firms typically came to control 67% of the local market within two years, sometimes acquiring every clinic in a county. Yet acquisitions did not generally produce new clinics, increase methadone treatment, change medication shipments or reduce opioid deaths. As of October 2026, private equity-affiliated firms owned 35% of U.S. providers, with majority ownership in 19 states and Washington, D.C. Supporters say investment can keep clinics open and help them accept Medicaid and Medicare; one operator also reports substantial growth through new sites. Still, evidence from buprenorphine treatment suggests increased patient volume can accompany worse treatment retention. A proposed federal bill would allow doctors to prescribe methadone and pharmacies to dispense it, ending clinics’ exclusive role and potentially widening access.