Pronounced Regional Disparities in Methadone Availability in the United States

John A. Furst BS
Geisinger Commonwealth School of Medicine

MedicalResearch.com: What is the background for this study?

Response: Methadone is an evidence-based pharmacotherapy for opioid detoxification, maintenance therapy, and pain management. However, accessibility of this treatment remains variable across much of the country. Methadone for the treatment of opioid use disorder (OUD) is exclusively provided by federally regulated opioid treatment programs (OTPs) and has provoked significant community-based and legal controversy regarding its role in the management of this condition. This has created disparities related to the distribution and access of methadone throughout the United States (U.S.). The goal of this study1 was to highlight the most recent pharmacoepidemiologic trends associated with methadone in the face of unique restrictions at the local, state, and federal levels.

MedicalResearch.com: What are the main findings?

Response: Between 2017 and 2019, distribution of methadone to OTPs increased by more than 10%, while decreasing by over 30% for the use in pain management. While every state saw a decrease in methadone distribution for pain, almost all states (44/50) saw an increase in the distribution for OTPs over this time span. The number of OTPs increased 11.5% nationally over these years, with the total number of OTPs per 100K population in 2019 ranging from 2.1 in Rhode Island to 0.0 in Wyoming.

MedicalResearch.com: What should readers take away from your report?

Response: The most striking finding was the statewide variation in number of OTPs per 100K population. States within the Northeast region of the U.S. demonstrated a much denser concentration of OTPs than many other states across the U.S., particularly compared to those in more rural regions like the Midwest. This sharp contrast represents potential treatment disparities and points to state specific factors that may be contributing to such differences. More research is needed to uncover the major contributing factors and to develop new treatment approaches to bridge gaps, particularly in rural regions of the U.S.

MedicalResearch.com: Is there anything else you would like to add?

Response: Our study demonstrates a need for further research into the geographical and legislative barriers related to OUD treatment, as well as the potential for qualified primary care settings and telehealth modalities to improve the accessibility of OUD treatment in the future. The COVID-19 pandemic has propelled a substantial transition to telemedicine across many areas of healthcare, and this may help to generate new research opportunities that offer a unique insight into the possibility of this platform to be used more regularly in the treatment of OUD. Expansion of the availability of evidence-based interventions for OUD is crucial as annual drug overdoses continue to increase.2 Additionally, we are greatly appreciative of the publicly available ARCOS database that made this research possible, and we encourage other researchers and journalists to utilize this source of data3 in future studies.


  1. Furst JA et al. Pronounced regional disparities in United States methadone distribution.
    Annals of Pharmacotherapy 2021:10600280211028262. doi: 10.1177/10600280211028262. https://pubmed.ncbi.nlm.nih.gov/34184584/
  1. Katz J, Sanger-Katz M. ‘Its huge, its historic, its unheard of’:Drug overdose deaths spike. NY Times. July 14, 2021. Accessed Sept 9, 2021 at: https://www.nytimes.com/interactive/2021/07/14/upshot/drug-overdose-deaths.html
  2. ARCOS Retail Drug Summary Reports. https://www.deadiversion.usdoj.gov/arcos/retail_drug_summary/index.html



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Last Updated on September 10, 2021 by Marie Benz MD FAAD