Opioid treatment programs (OTPs) are the only health care facilities that can offer patients all three forms of medication for opioid use disorder: methadone, buprenorphine, and injectable extended-release naltrexone. No other setting is permitted to provide methadone. These facilities are critical to reducing overdose deaths and providing lifesaving addiction treatment.
But too often, access to high quality OTP care is curtailed by federal and state rules that are not based in evidence. Although debate over the future of federal methadone regulation is ongoing, state policymakers have the opportunity to act now to improve access to this medication and the quality of OTP services by removing rules that go beyond federal restrictions and limit access to care. Pew reviewed OTP regulations across all 50 states and the District of Columbia as of June 2021 and found that, among other barriers to services:
20
states
Require a new OTP to seek state approval based on demonstrating a need for services before opening
7
states
Place restrictive zoning rules on OTPs that don’t apply to other health care facilities
10
states
Don’t allow clients to take medication home in the first 30 days of treatment
48
states
Allow OTPs to terminate patients for not being abstinent from opioids or other substances
23
states
Specify a counseling schedule — rather than providing individualized care
Use this interactive tool to explore how individual states regulate OTPs. You can explore by state or by regulation. Each type of regulation is characterized by its impact on access to care or patient experience.
Data represents state rules codified in statute and administrative code. It does not reflect any temporary changes such as executive orders or policy statements that states may have issued because of the COVID-19 pandemic.
Wyoming is not included in this interactive because the state does not have any OTPs or related regulations.
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Among the regulations reviewed, the District of Columbia has {{ currStateSupportsAccess }} regulations that supports access to care and {{ currStateLimitsAccess }} regulations that generally limits access to care. However, for one of these rules — state zoning restrictions — the regulation in place makes it easier to find treatment by requiring facilities to be located close to public transportation.
Additionally, {{ currStateImprovesExp }} regulations improves patient experience, while {{ currStateWorsensExp }} regulations worsens it.
Opioid treatment programs (OTPs) are the only health care facilities that can offer patients all three forms of FDA-approved medication for opioid use disorder (OUD): methadone, buprenorphine, and injectable extended-release naltrexone. But Pew found that nearly all states have rules governing OTPs that are not based in evidence and in turn limit access to care or worsen patient experience.
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Sheri Doyle
Senior Officer
Public Health Data Improvement
Frances McGaffey
Associate Manager
Substance Use Prevention and Treatment
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