Methadone Treatment Tripled Since 2010, But Most New Yorkers With Opioid Use Disorder Still Can't Get It
A Penn Medicine study shows methadone use tripled among Medicaid patients, but 75% with opioid use disorder still receive no medication. Federal legislation could expand access in New York.
Methadone use for opioid addiction has more than tripled among Medicaid patients over the past decade, according to research published this month in JAMA Health Forum. But the same study reveals a sobering gap: three out of four people with opioid use disorder still receive no medication treatment at all.
In New York, where Medicaid covers nearly half of all adults with opioid use disorder, the findings carry particular weight. While the state operates one of the country's most extensive treatment networks through the Office of Addiction Services and Supports (OASAS), access remains tightly restricted by decades-old federal rules that require patients to visit specialized clinics daily.
Now, a bill stalled in Congress would allow methadone to be prescribed in regular doctor's offices and picked up at any pharmacy — much like buprenorphine already can be. Advocates say the change could reach thousands of New Yorkers who need treatment but can't fit daily clinic visits into their lives.
The Research
Penn Medicine researchers analyzed Medicaid data from 1999 to 2020, tracking methadone use among enrollees nationwide. The pattern was clear: use rose slowly from 1999 to 2010, then accelerated sharply. By 2020, 6.2 out of every 1,000 Medicaid enrollees were using methadone for opioid use disorder — more than triple the rate in 2010.
Buprenorphine use grew even faster during the same period, but the researchers note that both medications fill different clinical needs. "Methadone is a more attractive treatment option for some patients with opioid addiction who fear the withdrawal that can occur when starting buprenorphine," said Dr. Ashish Thakrar, one of the study's lead authors and a senior fellow at Penn's Leonard Davis Institute.
The study underscores a larger problem: despite the rise in medication use, only about 25% of individuals with opioid use disorder receive any medication treatment, according to CDC data. That leaves millions without access to what medical research has consistently shown to be the most effective form of care.
Medicaid plays an outsized role in addiction treatment. The program insures 47% of all non-elderly adults with opioid use disorder in the United States as of 2023. In New York, Medicaid coverage for addiction services is more comprehensive than in most states, but regulatory barriers — not insurance — often determine who can access care.
Why Methadone Still Matters
Methadone has been used to treat opioid addiction since the 1960s. Unlike buprenorphine, which partially activates opioid receptors, methadone is a full agonist — it occupies the same receptors as heroin or fentanyl but does so steadily, without producing a high. For patients who've tried other medications without success, or who use high doses of potent opioids like fentanyl, methadone often works better.
The medication also carries none of the precipitated withdrawal risk that makes buprenorphine difficult for some patients to start. With buprenorphine, patients must wait until they're already in moderate withdrawal before taking the first dose — a requirement that can deter people from seeking treatment. Methadone can be started immediately.
"These medications allow people to focus on rebuilding their lives: finding housing, reconnecting with family, working, and managing other health conditions," Thakrar said. "In other words, these medications are not just symptom relief, but they are cornerstones to recovery. They are saving lives."
New York's overdose data supports that claim. The state saw a 32% drop in overdose deaths in 2025 compared to the previous year, a decline officials partially attributed to expanded medication access, including methadone programs.
Current Barriers in New York
Methadone for opioid use disorder can only be dispensed at federally certified Opioid Treatment Programs, also known as methadone clinics. In New York, OASAS licenses and regulates these programs. The state has clinics across all five boroughs, Long Island, and upstate cities like Buffalo and Rochester, but patients must typically visit in person every day to receive a supervised dose.
Take-home doses are available for stable patients, but federal regulations require documentation of compliance, counseling attendance, and negative drug screens before take-homes are granted. The rules were relaxed temporarily during COVID-19, but many have since reverted.
For someone working a job that starts at 7 a.m., or caring for children before school, the daily clinic requirement can be impossible. Clinics often operate on limited morning hours to accommodate dosing schedules. Missing a dose can trigger withdrawal. Missing several days can mean starting over.
Geography compounds the problem. While New York City has relatively dense clinic coverage, rural counties may have one clinic — or none. A patient in the Adirondacks faces a very different treatment landscape than someone in Brooklyn.
Pharmacies, meanwhile, can legally dispense methadone for pain management, but not for opioid use disorder. The same medication, different rules. That distinction is the target of the Modernizing Opioid Treatment Access Act.
The Legislative Push
The Modernizing Opioid Treatment Access Act (S. 644 / H.R. 1359) was introduced in Congress in March 2023 by a bipartisan group of senators and representatives. The bill would allow board-certified addiction specialists to prescribe methadone for opioid use disorder in outpatient settings, with patients picking up the medication at regular pharmacies.
Under the proposal, prescribing would be limited to physicians with addiction medicine certification — a safeguard intended to ensure clinical oversight. The DEA would register these practitioners under the same system currently used for buprenorphine and other controlled substances.
The bill also permits telehealth prescribing under certain conditions, mirroring changes already in place for buprenorphine. Patients could consult with addiction specialists remotely and have prescriptions sent to their local pharmacy — a structure that works in countries like Canada, the U.K., and Australia, where methadone is routinely dispensed through pharmacies.
Critics worry about diversion and safety. But supporters point out that methadone is already available through pharmacies for pain, and overdose data from countries with pharmacy-based dispensing doesn't show increased risk. A Penn LDI study published in 2025 found that expanded take-home methadone policies during COVID-19 did not lead to higher overdose rates.
As of February 2026, the bill has not advanced to a floor vote in either chamber. Advocacy groups including the American Academy of Emergency Medicine and the American Society of Addiction Medicine have endorsed the legislation.
What It Would Mean for NY Patients
If the bill passes, New York patients could potentially access methadone through primary care or addiction specialty clinics instead of enrolling in an Opioid Treatment Program. A patient in Albany seeing an addiction psychiatrist could leave with a prescription, fill it at CVS, and take doses at home under medical guidance.
This doesn't eliminate the need for counseling or monitoring — the bill still requires clinical oversight — but it removes the logistical barrier of daily clinic visits. For patients who work irregular hours, live far from clinics, or struggle with transportation, the change could mean the difference between accessing treatment and going without.
New York already has a robust network of addiction treatment providers, many of whom prescribe buprenorphine. If the federal rules change, those same providers could add methadone to their treatment toolkit, offering patients more options tailored to individual needs.
The change would also align methadone regulations with buprenorphine, which has been prescribable in office settings since 2000. Buprenorphine's expansion is widely credited with increasing access to medication treatment nationwide, though disparities persist.
Finding Methadone Treatment in New York
For now, methadone is available only through OASAS-certified Opioid Treatment Programs. The state maintains a directory of licensed programs, searchable by county.
Major providers include:
- NYC Health + Hospitals operates methadone programs at several locations across the five boroughs, including detox and maintenance treatment.
- Mount Sinai Addiction Institute runs a comprehensive Opioid Treatment Program offering both methadone and buprenorphine.
- Victory Recovery Partners recently expanded methadone services to Long Island locations in Farmingville, Hicksville, and Shirley.
Programs require an initial assessment, which may include a physical exam, urine drug screen, and evaluation by a counselor or physician. Once enrolled, patients receive daily observed dosing, typically in the early morning. Most programs also provide counseling, case management, and referrals for medical or psychiatric care.
OASAS online directory includes contact information and hours for all certified programs. Medicaid covers methadone treatment in New York. Uninsured patients may qualify for state-funded slots through local governments.
If you or someone you know needs help, OASAS operates a 24/7 helpline at 1-877-8-HOPENY (1-877-846-7369). The line offers referrals to treatment programs, crisis support, and information about insurance coverage.
Study citation: Hsu YC, Thakrar A, Leonard CE, et al. Trends in Methadone Use for Pain and Opioid Use Disorder Among Medicaid Enrollees. JAMA Health Forum. 2025;6(11). doi:10.1001/jamahealthforum.2025.0001
Written by
MTNYC Editorial TeamThe MTNYC Editorial Team is a group of healthcare writers, researchers, and addiction specialists dedicated to providing accurate, compassionate, and evidence-based information about addiction treatment and recovery resources in New York State.
