As the number of opioid-related deaths in the United States has increased nearly ten-fold from 1999 to 2023, methadone — a medication used to treat opioid use disorder — has proven to be an effective drug in reducing rates of mortality.
Available only at opioid treatment programs, expanding access to methadone has been identified as a key priority for public health officials. But new findings from a Brown study should spark discussion over whether reaching these goals may be at risk, said Yashaswini Singh, the study’s lead author and an assistant professor of health services, policy and practice.
The study found that while an increasing number of opioid treatment programs are being acquired by private equity firms, this has not led to an increase in methadone supply.
“Generally, there’s a lot of opacity and lack of transparency that surround these investments,” Singh said. “It’s really difficult to know where investments are flowing, in what regions and what the effects are for treatment or access to care.”
The rise in the number of OTP acquisitions by PE firms could partially be attributed to Medicare’s coverage of methadone beginning in 2020, she explained.
“With all these payment changes, it sort of led to an untapped revenue stream for investors because they’ve suddenly discovered a lucrative area thanks to regulatory changes that make payments more favorable,” Singh said.
According to the study, the number of OTPs acquired by PEs increased from 0.26% in 2011 to 18.9% by 2022. While methadone shipments were about 13% higher in PE-acquired OTPs compared to both non-acquired OTPs and PE-exposed OTPs, which are facilities located in areas with PE-acquired OTPs, these results were not found to be statistically significant after controlling for other variables.
Singh said these higher rates could suggest PE-acquired OTPs “were experiencing higher rates of methadone supply even before acquisition.”
“We can’t say for certain that it was a result of the acquisition itself,” Singh added.
The study presents one of the first findings that illustrate the impact of PE acquisitions on the quality or access to OTPs. In other healthcare settings including nursing homes or primary care physician practices, PE acquisition has been found to worsen patient care or increase costs, Singh explained.
While PE involvement in such settings is not inherently negative, more research is needed to determine the long-term impacts of such acquisitions on patient care. Singh added that treatment access can be expanded if investors increase capital to fund technological upgrades or expand hours of operation.
“We need to do a lot more work to understand what this really means for the patient,” she said.
Jonathan Kim is a senior staff writer covering Science and Research. He is a second-year student from Culver City, California planning to study Public Health or Health and Human Biology. In his free time, you can find him going for a run, working on the NYT crossword or following the Dodgers.
