For decades, people who took methadone, an FDA-approved medication for treatment of opioid use disorder, had to organize their lives around daily clinic visits. Work, childcare, transportation and recovery all had to bend around one rule: keep showing up every single day for supervised doses. That daily requirement, instituted by bureaucrats not medical providers, was rooted in decades-old concerns about diversion; policymakers believed that tight, in-person controls were necessary to prevent misuse. The result was a treatment system that, for many people, was simply too hard to stay in.
That began to change during the pandemic, when the Substance Abuse and Mental Health Services Administration (SAMHSA) issued flexibilities in the provision of take-home doses of methadone as well as telehealth pathways to treatment, allowing stable patients to receive up to 28 days of take-home methadone when clinically appropriate. In 2024, the Department of Health and Human Services (HHS) made these flexibilities permanent in its final rule on medications for opioid use disorder.
These were not radical experiments. They were practical updates to a treatment system that had long made access harder than it needed to be and the evidence supports keeping them in place.
As a result of these flexibilities, SAMHSA has reported that states, opioid treatment programs, and other stakeholders saw increased treatment engagement, better patient satisfaction and relatively few incidents of misuse or diversion under the pandemic-era take-home exemption. The subsequent 2024 rule was designed to preserve those gains and reduce barriers to care.
H.R. 5629 would void nearly all of the 2024 HHS rule, except the accreditation section. Rolling that back would not restore a neutral baseline. It would restore barriers that made treatment harder to start and harder to stay in.
That matters because access is still far too limited. SAMHSA reported that 4.8 million people age 12 or older had opioid use disorder in 2024, but only 17 percent received medication treatment in the past year. That is the gap policymakers should be trying to close, not widen.
We want to be direct here: accountability matters. Public dollars should be tracked carefully and treatment systems should be transparent. GHAI supports data transparency and responsible oversight of public funding.
But H.R. 5630 goes beyond grant oversight and it misplaces responsibility. Drug diversion enforcement is primarily the responsibility of the Drug Enforcement Administration (DEA), not Substance Abuse and Mental Health Services Administration (SAMHSA) grant managers or state opioid treatment authorities. By requiring diversion, misuse and screening reporting through the block grant, the bill pushes SAMHSA, states and grantees into a law enforcement monitoring role they were never designed to fill. The core purpose of the block grant is to expand access to prevention treatment, and recovery services. This bill moves it in a different direction.
At a time when the country has finally started to see real progress on overdose deaths, adding unfunded administrative burden to frontline programs is not a neutral ask. It has a cost that is measured in care that does not get delivered.
If Congress wants to strengthen accountability for how block grant funds are used, we welcome that conversation. But it should be done in ways that support programs, not strain them.
The Medication That Cuts Overdose Risk in Half
The case for protecting methadone access is grounded in decades of evidence. NIH reported that overdose deaths were 59 percent lower over the next year for those receiving methadone than for those receiving no medication treatment. A more recent federal study among Medicare beneficiaries found methadone was associated with 58 percent lower odds of a later fatal overdose.
The patient advocates and treatment providers broadly supported making the 2024 flexibilities permanent, simply because the evidence showed they worked and patients stayed in treatment.
The country has also started to see real progress in overdose trends. CDC reported that the U.S. drug overdose death rate fell 27 percent from 2023 to 2024, the largest single-year decline on record. That progress is fragile. It should make lawmakers more careful about disrupting access to proven treatment, not less.
The Cost of Losing Access to Care
People experience treatment barriers as missed appointments, lost wages, longer drives and more instability.
And people do not just disappear when they lose access to care. They end up in emergency rooms. They cycle through jails. First, responders pick up the bill. The Joint Economic Committee estimates the opioid epidemic cost the U.S. nearly $1.5 trillion in 2020 alone, up 37 percent from 2017. That cost does not go away when treatment access shrinks. It shifts.
More than half of all Americans report being personally affected by addiction, in their own life or through a family member or close friend. This is not a niche policy debate. It is a question about whether we protect the progress we have fought hard to make, or hand it back.
What Policymakers Should Do
The right test for any policy affecting treatment access is straightforward: does it expand access to evidence-based care, not undermine it?
The Global Health Advocacy Incubator’s Overdose Prevention Initiative supports policies that expand access to high-quality, evidence-based treatment. In response, we led a joint statement with other Overdose Prevention organizations making our collective position clear: policies that restrict access to medications for opioid use disorder don't create a neutral baseline, they actively push people out of care.
We welcome the opportunity to work alongside policymakers who share that goal, for people before, during and after recovery, each step of the way.
