Methadone treatment for opioid use disorder among Medicaid-insured individuals has increased significantly since 2010, according to a new analysis by Penn Medicine published in JAMA Health Forum. The study shows that while methadone can reduce the risk of overdose death by half, access remains limited, with only about a quarter of people with opioid use disorder receiving medication-assisted treatment.
“These medications allow people to focus on rebuilding their lives: Finding housing, reconnecting with family, working, and managing other health conditions,” said Ashish Thakrar, MD, assistant professor of General Internal Medicine at Penn’s Perelman School of Medicine. “In other words, these medications are not just symptom relief, but they are cornerstones to recovery. They are saving lives.”
The research examined national data from 1999 to 2020 on methadone and buprenorphine prescriptions among Medicaid recipients. Methadone usage was low in 1999; buprenorphine was approved for opioid use disorder in 2002. By 2010, methadone prescriptions rose from 0.7 to 1.9 per 1,000 Medicaid enrollees over the decade; buprenorphine reached 2.3 per 1,000.
After 2011, both treatments saw larger increases. Methadone prescriptions climbed steadily to reach 6.2 per 1,000 enrollees by 2020—triple the rate from ten years earlier—while buprenorphine users grew fivefold over the same period to about twelve per 1,000 enrollees.
“Potential explanations for these increases include both the worsening of the opioid epidemic and efforts to increase access to the treatments because of their significant impact on saving lives,” said Sean Hennessy, PharmD, PhD, professor of Epidemiology.
Researchers noted that buprenorphine's higher growth is likely due to its easier accessibility; it can be prescribed in outpatient settings such as primary care clinics. In contrast, federal law restricts methadone dispensing to certified opioid treatment programs.
“The regulation limits access to methadone, particularly in rural areas or urban spaces that lack adequate public transportation, and for people who might have some inflexible barriers like work or child care responsibilities,” Thakrar said.
Despite both drugs’ effectiveness at treating opioid addiction—and evidence showing those starting methadone are more likely than those starting buprenorphine to remain in treatment for six months or longer—methadone remains less accessible due to regulatory constraints.
“It is also a more attractive treatment option for some patients with opioid addiction who fear the withdrawal that can occur when starting buprenorphine,” Thakrar explained.
Recent government actions may help improve access: The Substance Abuse and Mental Health Services Administration (SAMSHA) has allowed more take-home methadone doses and legislation called the Modernizing Opioid Treatment Access Act was introduced in Congress in 2023. The bill would permit addiction specialists at outpatient clinics—not just licensed treatment centers—to prescribe methadone.
“This legislation could greatly expand access to methadone for opioid addiction because patients could access treatment from any clinical setting with an addiction specialist, not solely from licensed opioid treatment programs which have limited hours and space.” Thakrar said.
