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.
THE AMERICAN SOCIETY OF ADDICTION MEDICINE URGES SUPERVISED ADMINISTRATION IN THEIR GUIDELINES:
03 Other countries have tried this MOTAA-style approach and regretted it.
The United Kingdom, Canada, Sweden, and Denmark tried relaxing methadone prescribing safeguards.
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.
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.
- 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
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. 13-14 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. 1-5
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. 14
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.
What is AOAT’s position on methadone treatment regulation?
AOAT supports expanding access to methadone treatment while maintaining clinical oversight and patient-safety safeguards. AOAT supports the SAMHSA reforms that expanded take-home doses, telehealth initiation and mobile medication units within the OTP system, and opposes MOTAA’s proposed approach to methadone prescribing outside that system.
How does AOAT work to improve access to opioid addiction treatment?
AOAT advocates for policies that expand access to evidence-based opioid addiction treatment and help patients stay connected to care. This includes supporting SAMHSA’s OTP flexibilities, protecting Medicaid and other insurance coverage, reducing barriers such as unnecessary prior authorization requirements, and giving treatment providers greater flexibility to deliver individualized care.
References
1. Center for Substance Abuse Treatment. (2004). Methadone-associated mortality: Report of anational assessment (SAMHSA Publication No. 04-3904). Substance Abuse and Mental HealthServices Administration. https://atforum.com/documents/CSAT-MAM_Final_rept.pdf
2. National Drug Intelligence Center. (2007). Methadone diversion, abuse, and misuse: Deathsincreasing at alarming rate (Product No. 2007-Q0317-001). U.S. Department of Justice. https://www.justice.gov/archive/ndic/pubs25/25930/index.htm
3. Center for Substance Abuse Treatment. (2007). Summary report of the meeting: Methadonemortality—A reassessment. Substance Abuse and Mental Health Services Administration. https://www.atforum.com/pdf/Methadone_Draft_Report_101807_Brief-w-attch.pdf
4. U.S. Government Accountability Office. (2009). Methadone-associated overdose deaths:Factors contributing to increased deaths and efforts to prevent them (GAO-09-341). https://www.gao.gov/products/gao-09-341
5. Center for Substance Abuse Treatment. (2010). Methadone mortality: A reassessment.Substance Abuse and Mental Health Services Administration. https://cdn.vox-cdn.com/uploads/chorus_asset/file/19541909/Methadone_Mortality_A_2010_Reassessment.0.pdf
6. American Society of Addiction Medicine. (2020). The ASAM national practice guideline for thetreatment of opioid use disorder: 2020 focused update. Journal of Addiction Medicine, 14(2SSuppl 1), 1–91. https://doi.org/10.1097/ADM.0000000000000633
7. Strang, J., Hall, W., Hickman, M., & Bird, S. M. (2010). Impact of supervision of methadoneconsumption on deaths related to methadone overdose (1993–2008): Analyses using OD4 indexin England and Scotland. BMJ, 341, c4851. https://doi.org/10.1136/bmj.c4851
8. Aldabergenov, D., Reynolds, L., Scott, J., Kelleher, M. J., Strang, J., Copeland, C. S., & Kalk, N. J.(2022). Methadone and buprenorphine-related deaths among people prescribed and notprescribed opioid agonist therapy during the COVID-19 pandemic in England. InternationalJournal of Drug Policy, 110, 103877. https://doi.org/10.1016/j.drugpo.2022.103877
9. Tjagvad, C., Skurtveit, S., Linnet, K., Andersen, L. V., Christoffersen, D. J., & Clausen, T. (2016).Methadone-related overdose deaths in a liberal opioid maintenance treatment programme.European Addiction Research, 22(5), 249–258. https://doi.org/10.1159/000446429
10. Fugelstad, A. (2022). What lessons from Sweden’s experience could be applied in the UnitedStates in response to the addiction and overdose crisis? Addiction, 117(5), 1189–1191. https://doi.org/10.1111/add.15847
11. Gauthier, G., Eibl, J. K., & Marsh, D. C. (2018). Improved treatment-retention for patientsreceiving methadone dosing within the clinic providing physician and other health services(onsite) versus dosing at community (offsite) pharmacies. Drug and Alcohol Dependence, 191, 1–5. https://doi.org/10.1016/j.drugalcdep.2018.04.029
12. Sung, M. L., Black, A. C., Blevins, D., Henry, B. F., Cates-Wessel, K., Dawes, M. A., Hagle, H.,Joudrey, P. J., Molfenter, T., Levin, F. R., Fiellin, D. A., & Edelman, E. J. (2025). Clinician andpractice characteristics associated with support of office-based methadone: Findings from anational survey. Journal of Addiction Medicine, 19(2), 150–156. https://doi.org/10.1097/ADM.0000000000001388
13. Orgera, K., & Tolbert, J. (2019, May, 24). The opioid epidemic and Medicaid’s role in facilitatingaccess to treatment. KFF. https://www.kff.org/medicaid/the-opioid-epidemic-and-medicaids-role-in-facilitating-access-to-treatment/
14. Office of Inspector General, U.S. Department of Health and Human Services. (2024). Medicareand Medicaid enrollees in many high-need areas may lack access to medications for opioid usedisorder (OEI-BL-23-00160). https://oig.hhs.gov/documents/evaluation/9999/OEI-BL-23-00160.pdf
15. Substance Abuse and Mental Health Services Administration. (2025). Revised Regulations forOpioid Treatment Programs: Establishing a Baseline to Measure Progress Over Time. U.S.Department of Health and Human Services. https://library.samhsa.gov/sites/default/files/revised-regulations-otp-pep25-02-025.pdf
16. Centers for Disease Control and Prevention, National Center for Health Statistics. (2026).Provisional drug overdose data. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm