Paul Roberts, DO | Colonial Management Group
This comment was initially published on Feb. 18 2026 in response to a JAMA Network Open Original Investigation entitled, “Opioid Treatment Programs’ Medicaid Patient Retention Rates” by DeLisle et al.
We appreciate the important work of DeLisle, Mark, Katz, et al. in examining treatment retention within opioid treatment programs (OTPs). Retention is a critical quality indicator in the care of opioid use disorder (OUD), and one we closely monitor at Colonial Management Group, given the well-established association between continued treatment—particularly with medications for opioid use disorder (MOUD)—and reduced mortality.
We strongly support rigorous data collection and transparency around treatment outcomes. Public reporting of quality measures, including retention, can drive accountability and improvement across the continuum of care. For such reporting to be meaningful, however, it must be contextualized. Characterizing OTP retention rates as “low” warrants clarification in the absence of comparative benchmarks across other OUD treatment modalities or chronic disease care settings.
For example, a 2025 systematic review and meta-analysis in the Journal of Addiction Diseases found that methadone[1] showed significantly higher six-month treatment retention than buprenorphine-naloxone. OTPs are authorized to use all OUD treatment medications, and only OTPs can administer methadone for OUD, whereas office-based settings primarily administer buprenorphine-naloxone. To understand retention in context, consistent methods must be used to measure comparable outcomes across treatment settings.
OUD is a chronic, relapsing condition. As with other chronic illnesses, treatment trajectories are often non-linear. Patients may cycle in and out of care due to financial and insurance disruptions, transportation barriers, stigma, housing instability, co-occurring mental health conditions, or fluctuating readiness for change. Retention rates must therefore be interpreted within the clinical and social complexity of the population served.
OTPs are among the most highly regulated treatment settings in the SUD field and are subject to extensive federal and state oversight. However, OTPs, like many other settings providing MOUD, including office-based buprenorphine practices—are not uniformly required to publicly report retention or other quality metrics. As a result, cross-setting comparisons are difficult, and OTPs may appear uniquely scrutinized despite operating under more robust compliance frameworks.
The investigation appropriately highlights retention as a proxy for engagement in evidence-based care. Yet without established benchmarks—across treatment modalities, regions, or comparable chronic diseases—it is challenging to determine what constitutes a “low” retention rate. A more comprehensive understanding would include comparisons to other OUD treatment models and to adherence rates in chronic disease management programs.
Retention should also be considered alongside other meaningful outcomes, including reductions in illicit drug use, decreased overdose events, improved employment, housing stability, and patient-reported quality of life. Even intermittent engagement with MOUD may confer substantial protective benefit relative to no treatment.
We commend the authors for elevating the discussion around quality measurement in OUD treatment. The field would benefit from standardized, cross-setting reporting requirements and agreed-upon benchmarks to allow fair comparisons. Thoughtful interpretation of retention data—grounded in clinical reality and comparative context—will be essential to improving access to and continuity of evidence-based care.
Reference
1. https://pubmed.ncbi.nlm.nih.gov/40536198/
Read the full JAMA Network Open Original Investigation here.
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