Private Equity Ownership in Opioid Treatment Programs Does Not Increase Methadone Access

The trend of private equity firms acquiring opioid treatment programs (OTPs) across the United States has raised concerns about its impact on access to methadone, a critical medication proven to reduce overdose risk by over half. Despite a significant increase in private equity ownership—from just 0.26% of OTPs in 2011 to nearly 19% in 2022—the anticipated improvements in treatment availability and public health outcomes have not materialized. A comprehensive study published in Health Affairs analyzed data from 43 states, identifying 357 OTPs acquired by private equity firms during this period. Most acquisitions involved major private equity-backed platforms, especially in states hardest hit by the opioid epidemic, such as Ohio, Kentucky, and Tennessee. While private equity investments in healthcare more broadly tend to be concentrated in urban and populous areas, these regions experienced no significant rise in methadone shipments or reductions in opioid-related deaths post-acquisition.

Researchers employed advanced methodologies, including geocoding and manual verification of deals, to overcome the challenge of limited disclosure requirements for private equity investments. Their analysis revealed that, although private equity firms increased ownership, this did not translate into expanded methadone supply or enhanced treatment access. In fact, methadone shipments to OTPs grew only marginally—by about 13%—and these increases were not statistically significant after adjusting for other variables. Moreover, opioid mortality rates and methadone distribution at the county level remained stable regardless of ownership changes.

Expert commentary from lead author Yashaswini Singh emphasizes that these findings should prompt further examination of the role private equity firms play in addiction treatment. "When private equity ownership does not facilitate greater access or improve health outcomes, it raises questions about their true impact on the opioid crisis. Our study suggests that financial investment alone is insufficient to address the barriers to effective treatment."

Given the lack of transparency in private equity deals, the team relied on innovative data collection methods, including algorithmic matching and manual deal verification, to track acquisitions. The research highlights that private equity has acquired large shares—over two-thirds—of the opioid treatment market, predominantly in states most affected by the epidemic. Despite these investments, the core public health goal of increasing methadone access remains unmet. Singh calls for heightened scrutiny of for-profit ownership strategies in addiction treatment, advocating for policies that prioritize expanding treatment supply and reducing overdose deaths.