Expanding Access to Methadone and Buprenorphine through Policy Change
By Josh Rising
In June 2026, the federal Department of Health and Human Services (DHHS) put out a Request for Information (RFI) seeking input from the public on ways that the government could improve its response to the challenges of substance use and mental illness.
Faculty and staff with the Johns Hopkins Bloomberg School of Public Health’s Overdose Prevention Initiative team responded to the RFI with three specific ideas for policies that the federal government could implement with existing authorities. These policies focus on ways to expand access to buprenorphine and methadone; despite the body of evidence supporting the use of these medications to treat opioid use disorder (OUD), they remain widely underutilized.
The letter can be found here; below is a brief summary of the recommendations.
1. Ease regulations on methadone in long-term care facilities
Due to federal regulations, methadone to treat OUD is only available at opioid treatment programs (OTPs) and in some institutional settings (such as hospitals) that have their own pharmacies. These restrictions make it difficult for people in long-term care facilities (LTCFs) to continue methadone treatment as the LTCFs must arrange delivery of the medication with an OTP. This can be a significant barrier to continuing treatment, especially if the LTCF is in a rural area far from an OTP.
We suggest that DHHS work with the Drug Enforcement Agency to address this problem; one option would be to grant states a waiver if the state agrees to oversee the use of methadone in LTCFs.
2. Support buprenorphine initiation in emergency departments
A substantial body of literature has shown the benefits of starting buprenorphine treatment in the emergency department for people who have had an opioid overdose. Unfortunately, too many emergency departments are not prepared to do this.
Consistent with professional recommendations, we suggest that DHHS require that hospitals participating in Medicare to offer this life-saving treatment to people with OUD.
3. Educate the physician workforce to provide medication-based treatment
One significant barrier to the use of buprenorphine and methadone to treat people with OUD is that many physicians have not received appropriate training in these medications during medical school and residency.
DHHS could work with the addiction medicine community and the Accreditation Council for Graduate Medical Education around the development and implementation of appropriate standards for training programs across the country.
Improving access to evidence-based care, including medication-based treatment, is essential to addressing the overdose crisis. These policies, if implemented, would be an important step forward in reaching this goal and would save lives.
Please note: This letter represents the views of the signers only and not the views of their employers or institutions.
Josh Rising, MD, MPH, is a pediatrician with extensive experience, both inside and outside of government, working on strategies to address the opioid epidemic. He operates at the intersection of medicine, health policy, and public health, using his skills and expertise to advocate for evidence-based policies at the federal and state level that improve the health and well-being of communities.