March 26, 2026
By Patty McCarthy, CEO, Faces & Voices of Recovery
In 2024, after decades of outdated policy, the federal government finally modernized the rules that govern Opioid Treatment Programs (OTPs). These changes—formalized in updates to 42 CFR Part 8—were designed with one clear goal: to make life saving treatment more accessible, more humane, and more responsive to the real lives of people seeking recovery.
Now, there is growing concern that these reforms could be reversed.
As a person in long term recovery and as someone who has spent my career advocating for recovery oriented systems of care, I want to be very clear about what is at stake. Rolling back the 2024 OTP regulations would not be a neutral policy shift—it would actively harm people seeking treatment and undermine health, wellness, and long term recovery outcomes.
Why the 2024 OTP Regulations Mattered
For decades, OTP regulations were built around mistrust—of patients, of clinicians, and of recovery itself. The 2024 updates marked a fundamental shift toward patient centered, evidence based care that recognizes opioid use disorder as a chronic health condition, not a moral failing.1
The new regulations expanded access by:
• Removing non evidence based admission barriers, such as the one year opioid use requirement for adults and failed withdrawal attempts for youth
• Making permanent the expanded use of take home methadone doses based on clinical judgment rather than rigid timelines 2
• Ensuring people cannot be denied medication simply because they decline counseling, recognizing that recovery pathways are not one size fits all
• Centering shared decision making between patients and providers, including decisions about dosing, counseling, and supportive services
These changes aligned federal policy with decades of research and with what people in recovery have always known: access saves lives, and dignity sustains recovery.
What Happens If These Rules Are Reversed
Reversing the 2024 OTP regulations would mean reinstating barriers that have historically pushed people out of care—or kept them from seeking care at all.
First, access to treatment would shrink. Requirements like mandatory counseling participation or arbitrary waiting periods disproportionately impact people with unstable housing, inflexible jobs, caregiving responsibilities, or limited transportation. SAMHSA has explicitly acknowledged that flexibility and individualized care improve access and engagement. Rolling that back would predictably lead to more missed doses, more drop out, and more overdose risk.
Second, patient autonomy would be eroded. The updated rules emphasize shared decision making and respect for patient goals, allowing treatment plans to reflect real world needs rather than punitive compliance checklists. A reversal would return us to a system where control replaces care and fear replaces trust.
Third, health and wellness outcomes would worsen. Medications like methadone and buprenorphine reduce overdose risk and stabilize people so they can rebuild their lives. Policies that limit take home doses or delay treatment initiation increase exposure to a toxic and unpredictable drug supply. In today’s overdose crisis, those delays can be fatal.
The Impact on Recovery Is Not Abstract
Recovery is not just about stopping substance use—it is about health, connection, purpose, and quality of life. When people are required to structure their entire lives around daily clinic visits, rigid rules, and punitive surveillance, recovery becomes harder, not easier.
The 2024 regulations recognized that people in recovery are parents, workers, students, and community members. They acknowledged that stability grows when people are trusted and supported, not when they are micromanaged or punished for not fitting a narrow definition of “compliance”.
Rolling back these rules would send a devastating message: that the system values control over care, and ideology over evidence.
This Is a Recovery Justice Issue
At its core, this is a question of equity and justice. Restrictive OTP policies have always fallen hardest on people who are already marginalized—people of color, people with disabilities, people living in poverty, and people in rural or under resourced communities.
The 2024 reforms did not solve every problem, but they represented meaningful progress toward a system that meets people where they are. Undoing that progress would widen existing disparities and cost lives.
We Cannot Go Back
We know what works. SAMHSA’s own guidance makes clear that the updated OTP regulations were designed to expand access, improve engagement, and support long term recovery. Reversing them would ignore evidence, silence lived experience and abandon people at the very moment they reach out for help.
Recovery is possible. Treatment works. Policy should make recovery easier—not harder.
We owe it to people seeking treatment, to families who love them, and to communities across the country to protect and strengthen these reforms—not dismantle them.
References
1 https://www.vitalstrategies.org/wp-content/uploads/FederalOTPRegulations_Explainer_FINAL.pdf
2 https://www.federalregister.gov/documents/2024/02/02/2024-01693/medications-for-the-treatment-of-opioid-use-disorder