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September 5, 2025Open Access

Restrictive State Opioid Treatment Program Regulations Constrain Local Access To Methadone Maintenance Treatment

JDJ. Travis DonahoeUniversity of Pittsburgh NKNoa KrawczykNew York University JDJulie M. DonohueUniversity of Pittsburgh

Key Points

Restrictive state regulations significantly limit access to methadone maintenance treatment for opioid use disorder.
ZIP codes in low-restrictiveness states reported more than double the density of opioid treatment programs than those in high-restrictiveness states.
Comprehensive analysis of methadone shipments in 2019 highlights disparities in geographic access due to state regulations.
Easing strict OTP regulations may improve access to necessary treatment options for individuals suffering from opioid use disorder.

Abstract

State regulations governing opioid treatment programs (OTPs) vary widely in their restrictiveness, but how they affect geographic access to methadone maintenance treatment for opioid use disorder remains poorly understood. In this study of comprehensive data on methadone shipments to OTPs in 2019, we found that ZIP codes just across the border in states with low restrictiveness in OTP regulations had more than twice the OTP density and methadone shipments compared with nearby and otherwise similar ZIP codes in states with high restrictiveness. These findings suggest that restrictive state OTP regulations constrain geographic access to methadone maintenance treatment and that easing such restrictions is a viable strategy to expand access.

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