Private equity firms have acquired over a third of U.S. methadone clinics

Research generally found acquisitions did not increase treatment capacity

Private equity firms have acquired over a third of U.S. methadone clinics, and 35% of opioid treatment providers were affiliated with private equity firms as of October 2026. Research co-authored by Yashaswini Singh, a Brown University healthcare economist who studies how private equity is reshaping American medicine, with researchers from the University of Pittsburgh and RAND, generally found that the acquisitions did not expand methadone availability or produce new facilities. Singh said her work informed federal investigations into private equity’s role in expanding access to medications for addiction treatment.

Sen. Maggie Hassan, D-N.H., has an investigation into three of the country’s largest methadone clinic operators. The investigation cites concerns that the operators oppose expanded treatment access for financial reasons rather than patient safety.

Amber Titus, 38, and her husband live with their two young children in Bisbee Junction, Arizona, a rural community near the U.S.-Mexico border. The couple started taking methadone, a medication that treats opioid addiction, in early 2025. “It’s been a godsend,” she said. Three times a week, Titus wakes at 5 a.m. for a 45-minute drive each way to a methadone clinic in Sierra Vista. When the family has transportation, she makes the round trip with their 1-year-old son in a car seat.

The nearest clinic is about 30 miles from the couple’s home. It opens weekdays at 4:30 a.m. and closes before midday. Titus must receive her dose and reach work in Bisbee before a 9 a.m. shift, and she said arriving 10 to 15 minutes late can mean missing a dose even while the clinic remains open.

After their car was totaled in a crash in August, Titus called Medicaid, her insurance provider, to schedule rides until they got another vehicle. “They said they’d be at my house at 6 o’clock in the morning,” Titus told The Conversation. The driver was late every day. “I missed my methadone dose for the whole week,” she said.

Nationwide, more than 120 people a day died from opioid overdoses in 2025, according to federal estimates. Methadone is one of the most effective medications for opioid use disorder, cutting the risk of fatal overdose by roughly half, yet only 22% of people with the disorder ever receive it. For more than five decades, specialized, government-approved opioid treatment programs—not regular doctors or pharmacies—have dispensed methadone. Many require daily in-person visits, and average one-way drive times approach 50 minutes in rural communities.

Because methadone is tightly regulated, opioid treatment programs are, in effect, a government-created monopoly, Singh said. In most of the country, patients have a short list of licensed clinics and no other way to obtain methadone. Staff must observe patients taking their medication, and strict limits govern how much they may take home and when. Take-home methadone varies by state, time in treatment and clinician discretion; only 19% of people who received take-home methadone received three or more days’ supply.

Singh said the resulting guaranteed, captive demand can be profitable for private equity investors. Whoever controls the clinics in a region controls access to the medication and can set the terms for patients with the greatest need, she said. Private equity firms have invested more than $1 trillion in U.S. healthcare over the past two decades, from fertility clinics to hospice care. Singh noted that many Americans have never heard the term private equity, even as private equity firms now own more than 400 U.S. hospitals and oversee doctors in more than one-quarter of the country’s emergency rooms.

Singh described a platform-and-add-on strategy in opioid treatment: buying one large clinic and then steadily acquiring smaller nearby operations. She compared the approach with a company buying every gas station in a county over time. Individually, each deal looks too small to matter; collectively, one firm can end up controlling an entire region’s methadone supply.

Her previous research examined acquisitions from 2011 through 2019 and found that, within two years of a firm’s first purchase in a county, the firm typically controlled 67% of the local methadone treatment market. In more than one-quarter of counties, one firm controlled the entire market. Despite that concentration, the acquisitions generally did not produce new clinics or increase methadone treatment. Methadone shipments and opioid-related deaths were unchanged during the study period. Singh summarized the result: private equity firms had been buying capacity that already existed rather than building new capacity.

As of October 2026, 1,572 methadone clinics were registered with the Centers for Medicare & Medicaid Services. Nationally, 35% of opioid treatment providers were affiliated with private equity firms, and in 19 states and the District of Columbia, more than half had private equity owners. Community Medical Services, commonly known as CMS, owns all four methadone clinics in Montana, three of North Dakota’s four and the Sierra Vista clinic where Titus receives treatment. The company was operating in Montana before it was acquired by private equity.

CMS CEO Nick Stavros said the company had 14 clinics in four states before private-equity investment and now has 79 in 14 states, including five in prisons and three mobile units. He said 49 clinics, a majority of the company’s recent growth, came from new sites, unlike the typical private equity investment strategy of acquisitions. No expansion has taken place in Montana. Building a new clinic costs about $2.5 million, more than many rural areas can support, Stavros said.

In 2018, a prospective investor advised shutting down CMS’s Montana and North Dakota clinics because they were unprofitable. Stavros instead partnered with a different private equity firm to keep them open.

Singh said private investment is not inherently harmful. In markets where quality is easy to see, competition is robust and there is no government subsidy — restaurants, for instance — private equity can have neutral or even positive effects, she said. Healthcare has none of those features: patients often cannot judge provider quality, rarely pay for care directly, and government programs act as both payer and regulator.

Proponents tell lawmakers that private-equity capital has expanded treatment and modernized care, and they argue that private-equity ownership can fill gaps left by inadequate public funding for addiction treatment. Singh called the strongest evidence in proponents’ favor a study that found clinics became significantly more likely to accept Medicare and Medicaid after acquisition, likely because large chains can afford administrative infrastructure that small independent clinics cannot. She acknowledged that insurance-acceptance result as a real benefit. Singh said the picture was less favorable when the question shifted to whether more people entered and remained in treatment.

For buprenorphine, a related medication that can be prescribed more broadly than methadone, one study found patient volume at private-equity-acquired facilities rose about 22% after acquisition. Similar methadone data were unavailable. The same study found the share of patients who remained continuously on buprenorphine for 180 days — the national quality benchmark — fell by nearly 8 percentage points. Singh said early discontinuation is one of the strongest predictors of relapse and overdose.

Singh described an ongoing and severe opioid crisis. Federal data show that approximately 80% of the more than 100,000 drug overdose deaths in 2023 involved opioids. In 2024, overdose deaths declined to nearly 80,000, including more than 54,000 involving opioids. Singh argued that effective medications are already available and that barriers to access are not primarily clinical. The barriers are structural and, in this case, actively maintained by financial investors who profit from the status quo, she said.

Congress is considering the Modernizing Opioid Treatment Access Act 2.0, a bill that would let regular doctors prescribe methadone and pharmacies dispense it, breaking the decades-old rule limiting dispensing to opioid treatment programs. The original Modernizing Opioid Treatment Access Act was introduced in 2023 and, after facing opposition, did not reach a House or Senate vote before the congressional term ended. Lawmakers later reintroduced the proposal with changes as Act 2.0. The House Energy and Commerce and Judiciary committees were considering the bill, had not scheduled a markup as of October 2026, and the congressional term ends in January 2027.

Rep. Donald Norcross, D-N.J., one of the bill’s sponsors, said the need for the change became clear during a snowstorm years earlier when he noticed a single track of footprints crossing an otherwise empty street to a methadone clinic. “I realized that no matter what else is happening in the world,” Norcross said, “some of our neighbors’ lives literally revolve around getting to that building every single day.”

The bill has widespread support from patient-advocacy organizations and medical societies. A STAT investigation cited by Singh found that the main opposition comes from the American Association for the Treatment of Opioid Dependence, or AATOD, a major trade group representing methadone clinics. The coalition argues that expanded prescribing and pharmacy dispensing would increase diversion and overdose risk. Singh said the evidence so far did not support that claim. She also said firms that control large shares of their local markets may have a financial incentive to keep new competitors, including doctors and pharmacies, out.

AATOD president Mark Parrino said the group opposes the bill for two reasons: it would let the Health and Human Services secretary determine which additional practitioners are qualified to prescribe methadone for opioid use disorder, and it would allow methadone to be dispensed in dispersible tablet form as well as liquid. Parrino said tablets “were definitely” involved in a rise in methadone-related deaths that began around 1999. Singh said a Centers for Disease Control and Prevention and Food and Drug Administration advisory tied those deaths to methadone prescribed for pain, not addiction treatment.

Stavros, AATOD’s Arizona representative, said he did not see the bill as a threat to CMS’s business model. He cited concerns that removing regulation too quickly could allow a few bad providers to increase methadone overdoses and stigma. “We need to find ways to increase access,” he said. “If somebody would come up with … a slow, gradual transition that led to pharmacy prescribing,” Stavros said he would support it.

Dr. Melody Glenn, an associate professor of addiction and emergency medicine at the University of Arizona who previously worked at a methadone clinic in Tucson, supports Act 2.0 but said the legislation should go further. “It’s time to remove the regulatory barriers to these lifesaving medications,” Glenn said. She noted that the bill would allow doctors specializing in addiction medicine, like her, to prescribe methadone. Glenn said it was frustrating that an effective treatment existed while many people who could benefit never received it. “They don’t have to die,” she said.

Two other policy responses are gaining traction, Singh wrote. The first is ownership transparency. Private equity firms are exempt from the disclosure rules that apply to publicly traded companies, Singh said, while regulators, researchers and patients cannot scrutinize ownership they cannot see. Indiana, California and Maine have enacted or proposed reforms requiring disclosure of private equity and management-company ownership as a condition of billing Medicare or Medicaid. Vermont passed similar legislation this year, and Singh was invited to provide expert testimony on it.

The second response is lowering the reporting threshold for healthcare-company acquisitions so antitrust agencies can see more deals. The U.S. Department of Justice and Federal Trade Commission consider ownership of 30% or more of a local market for a product or service a red flag for anticompetitive behavior, and the laws are intended to promote competition and prevent monopolies. Singh’s research found that private equity chains typically controlled at least 67% of a local methadone market within two years of their first clinic purchase in a county.

Most acquisitions never trigger the federal reporting requirement because they occur through a series of smaller, piecemeal deals rather than one large merger. The requirement applies only to transactions worth more than about $134 million. Some states have proposed lowering healthcare thresholds to around $10 million so the vast majority of acquisitions become visible to enforcement agencies before they close.

Titus and her husband work for Cochise Harm Reduction, a grassroots nonprofit based in rural southeast Arizona that works to make life better for people who use drugs. “Addiction isn’t a choice,” Titus told The Conversation. She described seeking treatment as a process that eventually leads people to ask for help: “It’s a learning curve and eventually … you get tired of it and you want help.”

Aleka Kroitzsh, a researcher, and Kristi Tanner, senior accountability editor, contributed reporting. The author of this article is supported in part by Arnold Ventures, which also provides funding for accountability reporting at The Conversation. Singh is the Thomas J. and Alice M. Tisch assistant professor of health services, policy and practice at Brown University. The article was republished from The Conversation under a Creative Commons license. The views and opinions expressed in this commentary are solely those of the author.