When it comes to methadone treatment for opioid use disorder, Representative Erin Houchin, a Trump–supporting Republican from Indiana, wants to gut the 2024 Substance Abuse and Mental Health Services Administration’s (SAMHSA) updated guidelines for clinics with her federal bill.
She introduced HR 5629 in late 2025. The bill states, “To provide that the final rule of the Department of Health and Human Services titled, ‘Medications for the Treatment of Opioid Use Disorder’ except for the portion of the final rule relating to accreditation of opioid treatment programs, shall have no force or effect.”
SAMHSA’s 2024 final rule sped up the timetable for methadone patients to “earn” take-home medication. It allowed patients to receive up to seven days of take-home doses during the first 14 days of treatment, and to receive 28 doses within a month. When implemented, this has been life-changing for people who would previously have been tied to daily clinic visits, with all the disruption and surveillance that entails.
Houchin’s bill would roll back all of this progress as the opioid-involved overdose crisiscontinues.
SAMHSA’s 2024 made permanent the loosening of restrictions that was temporarily introduced during the COVID-19 pandemic. It additionally allowed patients to be admitted to an opioid treatment program (OTP) without having to show at least a one-year history of opioid dependence, and permitted initiation of treatment with methadone or buprenorphine via telehealth.
Houchin’s bill would roll back all of this progress as the opioid-involved overdose crisis continues.
In March, the House Energy and Commerce Subcommittee on Health held a hearing on the bill. Houchin stated: “Medications like methadone are effective for some, but are also associated with serious risks, including respiratory depression, cardiac complications, potential for misuse and diversion and dangerous interactions with other substances, particularly in today’s environment where illicit drugs are increasingly potent and unpredictable.” She also falsely claimed that methadone-related overdose deaths increased during the pandemic as a result of SAMHSA allowing more take-home medication.
Her statement is classic scaremongering and ignores decades of evidence that show the efficacy of methadone—and crucially, that its use reduces overdose deaths by over 50 percent. The medication is the gold standard of treatment, has been studied for over 40 years, and is used safely by millions of people around the world.
The problem with methadone isn’t diversion or dangerous interactions, it’s accessibility. The medication is locked inside of clinics that make it difficult to enter and to stay in treatment because of rigid rules like daily dosing, constant urine testing, mandatory counseling and limiting take-home medication.
Houchin’s questions insinuated that strict regulations were needed to decrease methadone-involved deaths and stop diversion. Those DEA talking points have been debunked.
At the hearing, Rep. Houchin questioned Dr. Yngvild Olsen, the former director of SAMHSA’s Center for Substance Abuse Treatment, who was centrally involved in writing the updated guidelines. Houchin was openly hostile to Olsen, instructing her to answer questions with only a yes or a no.
Her questions insinuated that strict regulations were needed to decrease methadone-involved overdose deaths and stop diversion. Those Drug Enforcement Administration talking points have been debunked by numerous studies, conducted during and after the pandemic.
Though the updated SAMHSA rules relaxed some restrictive regulations, here’s the catch: They are only recommendations, and are unenforceable. It’s up to each OTP to decide if they want to enact any of them. Many do not, especially when it comes to more take-home bottles.
So why is Rep. Houchin pushing a bill that repeals unenforceable regulations? Her office did not respond to Filter’s requests for comment.
The Drug Policy Alliance is among many organizations that support the updated SAMHSA guidelines and warn of deadly consequences from Houchin’s bill.
“Nullifying these parts of the final rule would have devastating impacts on people trying to access medication by reinstating barriers to treatment.”
“The Drug Policy Alliance opposes HR 5629, which would nullify updated rules that the communities we represent fought for,” Daniel Fishbein, policy manager for DPA’s Office of Federal Affairs, told Filter. “Nullifying these parts of the final rule would have devastating impacts on people trying to access medication across the country by reinstating barriers to treatment for opioid use disorder.”
“Currently, 80 percent of US counties do not have an OTP, meaning many people who are prescribed methadone must travel hours and wait in line just to get one daily dose,” Fishbein continued. “Eliminating take-home doses could make it impossible for someone who relies on this lifesaving medication to continue care—putting people’s recovery at risk, throwing them into painful withdrawal, and potentially driving them back into the illicit market.”
The American Association for the Treatment of Opioid Use Disorder (AATOD), the trade organization that represents OTP interests, submitted a Statement for the Record expressing “serious concerns” about HR 5629. Over 25 organizations signed on.
“We oppose the elimination of the SAMHSA regulations,” AATOD President Mark Parrino told Filter. “The Congresswoman [Houchin] does not seem to like methadone treatment.”
AATOD’s opposition should be seen in light of the fact that updated regulations make it easier for more people to enter treatment, which increases clinic profits. For AATOD, the SAMHSA guidelines don’t really matter; clinics retain total control over patients and a monopoly on the dispensing of methadone.
The American Society of Addiction Medicine sent a conciliatory letter to Rep. Houchin, stating it is ready to work with her and, “collaborative revisions are needed to make HR 5629 great.”
The Legal Action Center sent a strongly worded statement opposing HR 5629 and urged Congress not to pass the legislation. The American Society of Addiction Medicine (ASAM) sent a conciliatory letter directly to Rep. Houchin, stating it is ready to work with her and, “collaborative revisions are needed to make HR 5629 great.” ASAM recommended she endorse the Modernizing Opioid Treatment Access Act, a flawed bill that limits office-based prescribing of methadone to a small group of specialists and would increase racial disparities in access to the medication.
Houchin’s bill is an extraordinary intrusion into the medical practice of providing medication for opioid use disorder. But so are the involvements of SAMSHA; of the DEA, which registers and regulates OTP; and of the 50 State Opioid Treatment Authorities that license clinics and often enact yet more inhumane regulations.
Current regulations in Houchin’s home state of Indiana are among the most restrictive in the nation. The maximum number of take-home methadone doses permitted there is 14. The number of clinics allowed to operate in the Hoosier state is capped at 27. And opening an OTP requires a “certificate of need” demonstrating why it should be opened—which allows not-in-my-back-yard (NIMBY) groups to mobilize against new clinics.
Opioid treatment programs, highly stigmatized and siloed off from mainstream medical care, are vulnerable to attempts by right-wing politicians to repeal even modest reforms.
Houchin voted for the passage of the “One Big Beautiful Bill” that will cut nearly 1 trillion from Medicaid over 10 years. Medicaid is the largest payer for substance use disorder treatment in the United States, and around 40 percent of people with opioid use disorder rely on the program for health coverage.
Opioid treatment programs, because they are highly stigmatized and siloed off from mainstream medical care, are vulnerable to attempts by right-wing politicians like Houchin to repeal even modest reforms and to keep methadone locked in carceral clinics where patients are surveilled and punished for any rule infraction.
The only way to end these legislative attacks on people who take methadone and to free them from opioid treatment prisons is to end the separate and unequal clinic system, allow all health care providers to prescribe methadone, and integrate the medication into health care and community settings.
Photograph by Helen Redmond
The Influence Foundation, which operates Filter, previously received a restricted grant from DPA. Filter‘s Editorial Independence Policy applies.