One private equity–backed company owns every methadone clinic in Montana

Amber Titus, a 38-year-old mother of two living in rural Arizona, wakes up at 5 a.m. each weekday to travel 30 miles to a methadone clinic for opioid addiction treatment. The medication, prescribed to help her manage her addiction, has been a "godsend," she says. However, accessing the treatment is challenging due to stringent rules and limited clinic hours.

Titus must arrive at the clinic by 9 a.m., or she risks missing a dose, as clinic staff keep strict watch on patients and limit how much methadone they can take home. In August, Titus' car was destroyed in an accident, leaving her without a reliable transportation option. She then attempted to arrange rides through Medicaid, but the scheduled drivers were consistently late, causing her to miss her methadone dose for an entire week.

Despite methadone being one of the most effective medications for opioid use disorder, cutting the risk of fatal overdose by roughly half, only 22% of people with the disorder ever receive it. This is mainly because specialized clinics, known as opioid treatment programs, are the only places where methadone can be dispensed, and many require daily in-person visits.

For decades, these clinics have been a government-approved monopoly, with methadone treatment being accessible only through these specialized facilities. Recently, private equity firms have acquired a significant portion of the methadone clinic market in the U.S., claiming their investments have improved treatment and modernized care.

However, research published by a healthcare economist at Brown University indicates that despite owning over one-third of methadone clinics nationwide, private equity investments have not expanded methadone availability or led to the construction of new facilities. The study, conducted with researchers from the University of Pittsburgh and RAND, found that while private equity firms have acquired many clinics, methadone shipments and opioid-related deaths remained unchanged during the study period.

Private equity firms invest heavily in healthcare, having amassed over $1 trillion in U.S. healthcare investments over the past two decades, which includes owning more than 400 U.S. hospitals and overseeing doctors in more than a quarter of the country's emergency rooms. In the specific case of opioid treatment, these firms employ a platform and add-on strategy, buying one large clinic and gradually acquiring smaller ones nearby, eventually gaining control of an entire region's methadone supply.

Private equity firms argue that their investments have expanded treatment and modernized care, but the data suggests otherwise.