Advocates for Opioid Addiction Treatment
MOTAA misses the mark.
The Modernizing Opioid Treatment Access Act (MOTAA 2.0) is dangerous for patients and the public. We urge Congress to reject S. 4941.
Opioid treatment programs (OTPs) support expanding access to evidence-based treatment for opioid use disorder (OUD), but access must be expanded safely. MOTAA is the wrong approach.
What would MOTAA do?
MOTAA would eliminate longstanding federal safety safeguards. It would open the door for providers with no training in methadone, to prescribe this Schedule II narcotic for pharmacy dispensing to patients living with OUD for unsupervised use– no diversion controls, no clinical oversight, no comprehensive program.
S. 4941 would recreate the “pill mill” prescribing environment that fueled the opioid crisis and put patients and public safety at risk – just like it did in the early 2000s when physicians were prescribing methadone for pain.
7 reasons to reject MOTAA
01 Methadone can easily result in overdose.
Enough to cause dozens of fatal overdoses if diverted, misused or accidentally injected.
02 Studies demonstrate methadone prescribed outside of OTPs leads to increased diversion, overdose, and death.
found that the vast majority of methadone overdoses in the early-to-mid 2000s were attributable to physicians prescribing methadone for unsupervised pharmacy pick-up and use– putting patients and communities at risk as diversion, overdose and death increased dramatically.
THE AMERICAN SOCIETY OF ADDICTION MEDICINE URGES SUPERVISED ADMINISTRATION IN THEIR GUIDELINES:
The administration of methadone should be monitored because unsupervised administration can lead to misuse and diversion. OTP regulations require monitored medication.
03 Other countries have tried this MOTAA-style approach and regretted it.
The United Kingdom, Canada, Sweden, and Denmark tried relaxing methadone prescribing safeguards.
They all saw higher methadone-related overdose deaths, increased diversion, and lower patient treatment retention.
When countries reinstated supervised and controlled dosing, they saw substantial declines in methadone-related overdose deaths.
04 There is strong opposition among providers and law enforcement.
Law enforcement groups oppose liberalizing methadone in this way.
of physicians who prescribe OUD medications did not support prescribing methadone via pharmacies.
In addition to AOAT, the American Association for the Treatment of Opioid Dependence and the National Association for Behavioral Healthcare reject MOTAA.
05 MOTAA will not meaningfully expand access.
MOST ADDICTION PROVIDERS DON’T ACCEPT MEDICAID:
- of low-income non-elderly OUD patients are uninsured or on Medicaid
- of addiction medicine specialists accept Medicaid patients.
of the U.S. population already have reasonable access (within 40 minutes/ 30 miles) to MAT with methadone at an OTP
The would-be MOTAA prescribers overwhelmingly practice in these same communities.
06 MOTAA ignores the critical role that comprehensive care plays in addiction treatment.
Opioid Treatment Programs (OTPs) have the best retention rates for treatment
because methadone is part of a comprehensive evidence-based approach offering counseling, case management and long-term recovery support services. MOTAA offers none of those things.
07 Through bipartisan legislation and recent SAMHSA-led reforms, progress is already being made to expand access and individualize treatment while maintaining the patient and public safety protections and comprehensive care that have guided methadone treatment for decades.
DATA AGGREGATED FROM FOUR OTP NETWORKS REPRESENTING 382 TREATMENT CENTERS DEMONSTRATE HOW CARE IS BECOMING MORE INDIVIDUALIZED AND ACCESSIBLE DUE TO THE SAMHSA REGULATORY FLEXIBILITIES:
of patients come into the clinic once a week or less
receive at least 3 take-homes a week
of patients are initiated through telehealth
Data aggregated from four OTP networks representing 382 treatment centers
A recent SAMHSA report found that 71% of OTPs have implemented at least half of the changes and 93% of OTPs have implemented at least a quarter of the changes. Importantly, state regulations can be more stringent and prevent OTPs from fully individualizing treatment – only 17 states have adopted all the SAMHSA flexibilities.
Between November 2022 and November 2025, the U.S. saw a 37% reduction in opioid overdose deaths.
To protect patient and community safety, regulatory changes must be made cautiously. We urge Congress to reject MOTAA.
FAQ about MOTAA
Does MOTAA S.4941 address geographic access issues?
MOTAA would only liberalize access to methadone in communities where critical protections are already in place and working. In fact, 87% of the U.S. population already has reasonable access (within 40 minutes/30 miles) to MAT with methadone at an OTP. Not surprisingly, the would be MOTAA prescribers overwhelmingly practice in these same communities.
Additionally, most addiction providers don’t accept Medicaid. While 74% of low income non-elderly OUD patients are uninsured or have Medicaid coverage, only 38% of addiction medicine specialists accept Medicaid patients. As the 2025 HHS’ Office of Inspector General’s report stated, “If providers are unable or unwilling to treat Medicare and Medicaid enrollees, these actions [policy changes] will have limited success in expanding access to treatment.”
Would MOTAA S.4941 be harmful to communities?
Methadone is a powerful Schedule II narcotic with a high risk of overdose and death if improperly prescribed, misused, or diverted.
The current OTP system was specifically designed to ensure methadone treatment is paired with comprehensive clinical oversight, including careful patient assessment,
methadone titration, counseling, toxicology screening, monitoring and diversion controls. MOTAA would eliminate these safeguards by separating methadone prescribing from the comprehensive treatment programs that support patient safety and long-term recovery.
Five federal reports examining methadone-related overdose deaths in the 2000s found that most methadone overdose deaths were associated with physician prescribing for unsupervised pharmacy pick-up and use. As methadone prescribing expanded outside structured treatment settings, diversion, overdoses and deaths increased dramatically.
Dispensing methadone through retail pharmacies could significantly increase the amount of methadone circulating in communities while reducing the oversight currently in place to prevent misuse and diversion.
Similar experiences have been documented internationally. Countries including the United Kingdom, Canada, Sweden and Denmark experienced increased methadone- related overdose deaths, diversion and poorer treatment retention after relaxing methadone safeguards. When supervised dosing requirements were strengthened, overdose deaths declined.
Not surprisingly, law enforcement organizations across the country oppose MOTAA.
Will MOTAA S.4941 meaningfully expand access to the uninsured?
Most patients with OUD rely on Medicaid or are uninsured, yet many addiction specialists do not accept Medicaid or practice in underserved areas. Only 38% of addiction medicine specialists accept Medicaid patients.
As a result, access expansion under MOTAA would likely remain concentrated in communities that already have addiction specialists. Without addressing provider participation in Medicaid or broader treatment capacity challenges, MOTAA is unlikely to significantly improve access for the populations facing the greatest barriers to care.
Approximately 87% of the U.S. population already lives within 30 miles (or 40 minutes) of an OTP offering methadone treatment, and many of the providers who would become eligible under MOTAA already practice in these same communities.
How has SAMHSA already expanded access safely?
SAMHSA has already modernized OTP care by expanding take-home medication privileges, allowing telehealth initiation of treatment and authorizing mobile medication units. According to SAMHSA, 93% of OTPs have implemented at least a quarter of the changes. Data aggregated from four AOAT member networks representing 382 treatment centers demonstrate how care is becoming more individualized and accessible due to the SAMHSA regulatory flexibilities: 50% of patients come into the clinic only once a week or less; 78% receive at least 3 take-homes a week; 29% of patients are initiated through telehealth.
Many states have yet to adopt the full SAMHSA flexibilities, which hinder OTPs in providing individualized care. SAMHSA also recently reported that only 17 states report adopting all the flexibilities.
Congress should allow these reforms to continue working rather than creating a parallel methadone system outside established OTP oversight and required patient safety standards.