The Modernizing Opioid Treatment Access Act 2.0
The Modernizing Opioid Treatment Access Act 2.0
The addiction crisis is evolving. Our treatment system must evolve with it.
The Modernizing Opioid Treatment Access Act 2.0
The Modernizing Opioid Treatment Access Act 2.0 (MOTAA 2.0) would advance integrated and patient-centered approaches to methadone treatment for opioid use disorder (OUD) 鈥� through qualified practitioner prescribing and pharmacy dispensing, bringing care closer to patients with strong safety guardrails.
Why MOTAA 2.0 Matters
- Expands access to a lifesaving treatment
- Has strong federal and state oversight and safety guardrails
- Supports rural and underserved communities
- Further aligns addiction treatment with mainstream healthcare
Decades-old federal restrictions can make methadone treatment for opioid use disorder (OUD) difficult for Americans to access. Federal rules largely limit this FDA-approved treatment to opioid treatment programs (OTPs). But roughly 80% of U.S. counties don’t have one.1
With only about 2,100 OTPs nationwide, many patients travel long distances and risk missing doses. Relying on a single care setting can also limit flexibility as patients’ needs differ and change. This system ties a patient’s OUD care to the nearest OTP, even when they may benefit from services their OTP can’t offer, like other medications. Patients often transition between levels of care—including outpatient programs, residential treatment, and primary care—but these transitions are hard to make when patients are tethered to the closest OTP in order to continue receiving methadone treatment.
An Integrated Solution: The Modernizing Opioid Treatment Access Act 2.0 (MOTAA 2.0)
MOTAA 2.0 (S.4941) would allow highly trained practitioners, including addiction specialist physicians, to prescribe methadone for OUD that can be dispensed at community pharmacies under appropriate federal and state oversight. This helps bring an effective addiction treatment into the mainstream healthcare system.
MOTAA passed the Senate HELP Committee on a bipartisan basis in December 2023. This new, updated version (MOTAA 2.0) adds additional safety guardrails while responsibly expanding access to methadone for OUD.
MOTAA 2.0 FAQ
Addiction medicine physicians and addiction psychiatrists who obtain a separate registration from the DEA could prescribe methadone for OUD, as allowed by state law. The HHS Secretary could add other qualified prescribers, who would remain subject to applicable state scope-of-practice laws. Prescriptions could be written for either unsupervised or supervised use.
States would set dispensing limits for MOTAA 2.0 prescriptions, alongside federal Schedule II controls.
Only liquid or dispersible tablet forms could be prescribed for OUD and dispensed from pharmacies. Standard tablets could not be dispensed from pharmacies for OUD under MOTAA 2.0.
Currently, methadone dispensed through OTPs is generally not reported to state prescription drug monitoring programs (PDMPs) due to legal and operational barriers. As a result, one of the most tightly regulated controlled substances in American medicine is largely invisible to the wider medical community. That lack of visibility limits real鈥憈ime clinical oversight and diversion monitoring. By permitting pharmacies to dispense methadone for OUD, MOTAA 2.0 prescriptions could be routinely entered into state PDMPs like other Schedule II medications.
This would create a clear and auditable record that supports coordinated care, identifies potential misuse, and gives states data鈥慸riven tools to monitor and respond to diversion risk.
MOTAA 2.0 would take effect 180 days after enactment, giving federal and state policymakers time to prepare.
Expand all
Collapse all
MOTAA 2.0 can unlock integrated care models that combine the onsite delivery of primary care, specialty addiction treatment, and recovery support services across the country.
Understanding Opioid Use Disorder Treatment
Medications for Opioid Use Disorder (MOUD)
Medications for opioid use disorder (MOUD) are a first-line treatment for OUD. MOUD are the standard of care for OUD, reducing cravings and withdrawal symptoms. They are often combined with psychosocial treatment, counseling, and other supports. This individualized approach to patient care helps patients find stability and build a life in their community that is meaningful to them. This can include strengthening family relationships, maintaining employment, and more.
There are three FDA-approved medications for treatment of OUD:
Buprenorphine
Naltrexone
Methadone
Methadone is a highly effective treatment, but it is still kept separate from much of the healthcare system. MOTAA 2.0 would help fix this and expand patient access.
Treatment Settings
Treatment for OUD can take place in a variety of treatment settings or levels of care. These include low-intensity settings like outpatient and intensive outpatient care, and higher-intensity settings like residential and inpatient care. Patients often transition between these levels of care as their needs change, but these transitions are currently difficult to make when a patient is prescribed methadone. When outpatient methadone is largely limited to one setting — opioid treatment programs (OTPs) — it limits patient flexibility.
Current Federal Policy Limits Legitimate Medical Access to Methadone, a Proven OUD Treatment
Methadone saves lives: This gold-standard treatment cuts all-cause mortality by more than 50% and significantly reduces the risk of fatal overdose.2
An effective treatment for the fentanyl era: People exposed to high-potency synthetic opioids (like fentanyl, nitazenes, and orphines) may stay in treatment longer with methadone than with other medications.3
Methadone has been singled out as the only medication in U.S. healthcare governed by rigid federal regulations governing the practice of medicine.
MOTAA 2.0 Would Promote:
- Greater patient and provider choice.
Addiction treatment in more integrated settings.
Access for rural communities without opioid treatment programs (OTPs).
Improved patient safety through state prescription drug monitoring program reporting.
Advocates are Calling for MOTAA 2.0
MOTAA 2.0 is endorsed by a broad coalition of over 50 organizations representing physicians, pharmacists, patients, and more. See a list of organizations
Data
1 Duff JH, Carter JA. Location of Medication-Assisted Treatment for Opioid Addiction: In Brief. 2019.
2 Santo T, Jr., Clark B, Hickman M, et al. Association of Opioid Agonist Treatment With All-Cause Mortality and Specific Causes of Death Among People With Opioid Dependence: A Systematic Review and Meta-analysis. JAMA Psychiatry. 2021;78(9):979-993. doi:10.1001/jamapsychiatry.2021.0976
3 Nosyk B, Min JE, Homayra F, et al. Buprenorphine/Naloxone vs Methadone for the Treatment of Opioid Use Disorder. JAMA. 2024;332(21):1822-1831. doi:10.1001/jama.2024.16954
4 National Association of State Alcohol and Drug Abuse Directors. Technical Brief: Census of Opioid Treatment Programs. 2022. Accessed March 28, 2025. https://nasadad.org/wp-content/uploads/2022/12/OTP-Patient-Census-Technical Brief-Final-for-Release.pdf
5 Krawczyk N, Rivera BD, Jent V, Keyes KM, Jones CM, Cerdá M. Has the treatment gap for opioid use disorder narrowed in the U.S.?: A yearly assessment from 2010 to 2019". Int J Drug Policy. Jul 19 2022:103786. doi:10.1016/j.drugpo.2022.103786
6 Amiri S, Lutz R, Socías ME, McDonell MG, Roll JM, Amram O. Increased distance was associated with lower daily attendance to an opioid treatment program in Spokane County Washington. J Subst Abuse Treat. Oct 2018;93:26-30. doi:10.1016/j.jsat.2018.07.006
7 Hutchison M, Russell BS, Leander A, et al. Trends and Barriers of Medication Treatment for Opioid Use Disorders: A Systematic Review and Meta-Analysis. Journal of Drug Issues. 2023;55(2):193-214. doi:10.1177/00220426231204841
8 Platt L, Minozzi S, Reed J, Vickerman P, Hagan H, French C, Jordan A, Degenhardt L, Hope V, Hutchinson S, Maher L, Palmateer N, Taylor A, Bruneau J, Hickman M. Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs. Cochrane Database of Systematic Reviews 2017, Issue 9. Art. No.: CD012021. DOI: 10.1002/14651858.CD012021.pub2
9 Tsui JI, Evans JL, Lum PJ, Hahn JA, Page K. Association of Opioid Agonist Therapy With Lower Incidence of Hepatitis C Virus Infection in Young Adult Injection Drug Users. JAMA Intern Med. 2014;174(12):1974–1981. doi:10.1001/jamainternmed.2014.5416.