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Health
Two years after rules overhaul, have methadone clinics really changed?
More addiction clinics offer ‘take-home’ medication, but questions remain about size of cultural shift
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Jessica Rinaldi/Globe Staff
By Lev Facher<br>Aug. 14, 2026
Addiction Reporter
Lev Facher<br>[email protected]
Lev’s reporting has explored Americans’ deadly hostility to addiction medications, subpar treatment offered in jails and prisons, shifts in the illicit drug supply and consumption behavior, controversies surrounding harm reduction, and recent innovations in addiction medicine. You can reach him on Signal at levfacher.51.
Methadone clinics are finally getting their report card.
In 2024, with the specialized addiction treatment providers facing backlash from patient groups and scrutiny from lawmakers, the federal government issued a long-awaited overhaul of regulations that determine how the clinics operate.<br>Advertisement
The changes included greater flexibility over “take-home” medications, and stressing that counseling should be offered to patients but not required as a condition of receiving their medication.
The real question, however, was never how big the regulatory changes would be. It was whether clinics, and the state-level agencies that oversee them, would make the sweeping cultural shift. In recent months, a picture has finally begun to emerge. According to data collected by industry groups and the federal government, a significant share of opioid treatment programs, as the clinics are known, have implemented major changes.
“A significant majority of OTPs have incorporated the changes,” said Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, a New York-based advocacy group that represents methadone clinics. “I’d say more than 75% of the programs have, in fact, provided more take-home medication … and the result has been, as the study captured, that retention in treatment has significantly increased.”<br>Advertisement
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Rigid rules at methadone clinics are jeopardizing patients’ path to recovery from opioid addiction
Methadone, a powerful medication used to quell withdrawals and help people addicted to opioids achieve stability, is the most effective tool for treating opioid addiction. But for decades, it has existed in a silo, walled off from the rest of the American medical system. Historically, clinics had typically required patients to attend in person each day to receive their methadone dose, posing substantial challenges for people with jobs or families, or who lived far away.
Since 2020, however, methadone clinics have undergone a fast-paced evolution. Amid the Covid-19 pandemic, fearful of disease spread, the Substance Abuse and Mental Health Services Administration gave clinics permission to issue weeks’ worth of “take-home” medications that allowed patients to keep their methadone at home.
The regulations issued in 2024 made many of those changes permanent, and more broadly, pushed clinics and state-level regulators to leave punitive, rigid attitudes in the past. Some industry leaders have since embraced the shift, concluding that they can provide high-quality care even if their patients don’t show up in person most days.
The new regulations have “shifted the mindset to motivation rather than mandating,” Dustin Mets, CEO of CompDrug, an Ohio-based behavioral health clinic, said during a recent SAMHSA webinar.
“OTPs are getting more comfortable with exercising greater discretion in balancing safety, patient preference, and other factors, in ways that we frankly didn’t have the leeway to do before,” he said. “We’re discovering [that] physical presence is a rather poor proxy for a strong therapeutic relationship.”
Mets, and other federal officials and industry leaders, cited results from a survey conducted by AATOD, Parrino’s...