Testimony in Support of Senate Bill 398, “a bill to amend… public health code
Testimony from:
Stacey McKenna, Resident Senior Fellow, Integrated Harm Reduction, R Street Institute
Testimony in Support of Senate Bill 398, “a bill to amend… public health code.”
March 4, 2026
House Committee on Health Policy
Chairman VanderWall, Vice Chair Thompson, Vice Chair Whitsett and members of the Health Policy Committee:
My name is Stacey McKenna and I am a resident senior fellow in Healthier Communities at the R Street Institute. R Street is a policy research organization that engages in research and outreach aimed at solving complex issues, including opioid use disorder (OUD), through free markets and limited but effective government. OUD is a complicated health challenge and recovery is a nonlinear process that requires access to evidence-based care and individualized treatment options.[1] Unfortunately, both state and federal policy hinder people’s ability to access or adhere to the gold standard treatment methadone via excessive regulatory barriers.[2] SB 398 is of special interest to us because it would reduce unnecessary overregulation, increasing provider decision-making, facilitating competition to improve quality of care, and increasing access. Together, these factors would make it easier for individuals with OUD to get the care they deserve.
An estimated 2.7 to 7.6 million people in the United States are currently living with an opioid use disorder (OUD).[3] Although overdose fatalities across the nation and in Michigan have been declining in recent years, the unpredictable nature of the illicit drug supply continues to make OUD a dangerous, life-threatening condition.[4] Michigan saw more than 1,500 opioid-involved deaths in 2025.[5]
For decades, OUD and overdose have had devastating effects on communities across the nation. Due to the proliferation of fentanyl over the past 10 years, more than 40 percent of people in the United States now know someone who died of a drug overdose.[6] In addition to the emotional toll of losing a friend or watching a family member struggle with addiction, the OUD and overdose crisis comes with financial costs. In 2024, opioid use cost Michigan $38 billion in lost productivity and wages, criminal activity and associated carceral system contacts, and health care.[7]
Methadone is an FDA-approved medication that prevents opioid withdrawal symptoms and cravings, enabling patients to reduce or stop using illicit substances and rebuild their lives.[8] Because drugs on the illicit market are so potent—causing a strong dependence and high opioid tolerance—it is widely considered the best of the available medications for many patients with an OUD.[9] Compared to people with an OUD who are engaged in non-medication treatment, individuals taking methadone are up to four times as likely to stay in treatment and 80 percent less likely to die of a drug overdose.[10] They are also more likely to quit using illicit substances altogether, and less likely to engage in criminal activity.[11]
Despite all these benefits, only about 20 percent of Americans with an OUD receive methadone Treatment.[12] This is largely due to decades of federal and state regulations that make methadone difficult to access and undermine the associated quality of care.[13]
In the United States, methadone is only available for the treatment of OUD through a system of “opioid treatment programs” (OTPs). Michigan has 55 of these specialty clinics; however, OTPs are not evenly distributed by geography or need, often concentrated in urban areas.[14] Consequently, millions of Americans live more than a two-hour drive from their nearest OTP and the average travel time using public transit (more common for OTP participants) is 45.6 minutes.[15] Drive times of 10 minutes or more are associated with a 33 percent reduction in likelihood a person will complete treatment.[16] That is because many OTPs—often due to state regulations—require patients to visit the clinic as often as six days per week to take their methadone under supervision.[17] Furthermore, many clinics have long wait times, limited operating hours, and strict counseling schedules that do not allow providers to individualize care.[18]
SB 398 would help overcome some of these issues, improving both OTP (and thus methadone) access as well as increasing evidence-based and patient-centered care. The proposed bill would do this by authorizing methadone mobile units and prohibiting the overregulation of OTPs in ways that are out of line with decades of available research.
Providing methadone via mobile units helps increase access to methadone for vulnerable and underserved people with OUD, including those living in rural areas. In addition, the units improve treatment retention.[19] Meanwhile, efforts to overregulate OTP operations—for example, by requiring medication discontinuation as a goal of treatment or restricting the number of mobile or brick-and-mortar OTP locations—do not improve quality of care or treatment outcomes.[20] Conversely, reducing regulations in ways that allow more patient-centered care and provider decision-making while facilitating competition leads to higher patient satisfaction and better treatment outcomes.[21]
Furthermore, expanding and improving methadone access and treatment is safe for communities. Diversion—the distribution, acquisition, and use of prescription drugs in ways other than prescribed or outside of formal channels—of medications for opioid use disorder is rare, and when it does happen, it is typically therapeutic.[22] For example, people may use diverted buprenorphine or methadone to reduce their use of illicit opioids, to avoid withdrawal symptoms, or to initiate informal treatment when official channels are unavailable or inaccessible.[23] Therefore, expanding methadone access through mobile units and targeted regulatory cuts would greatly increase and simplify access to formal treatment access and be unlikely to increase diversion.[24] This assumption is supported by Covid-19-era policies that relaxed methadone regulations and did not lead to increases in diversion or overdose.[25]
Methadone is one of the best tools we have in the fight against the overdose crisis. By allowing OTPs to operate mobile methadone dispensing units, and preventing the overregulation of mobile and stationary clinics, SB 398 would improve access to this life-saving medication. Therefore, we urge a favorable report of SB 398.
Thank you,
Stacey McKenna
Resident Senior Fellow, Integrated Harm Reduction
R Street Institute
smckenna@rstreet.org
[1] The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update, American Society of Addiction Medicine, 2020.
https://www.asam.org/quality-care/clinical-guidelines/national-practice-guideline.
[2] The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update, American Society of Addiction Medicine, 2020.
https://www.asam.org/quality-care/clinical-guidelines/national-practice-guideline.
[3] “Opioid Use Disorder,” Centers for Disease Control and Prevention, Aug. 30, 2022. https://www.cdc.gov/dotw/opioid-usedisorder/index.html#:~:text=About%202.7%20million%20people%20in%20the%20United%20States%20report%20suffering%20from%20OUD;
Noa Krawczyk et al., “Has the treatment gap for opioid use disorder narrowed in the U.S.?: A yearly assessment from 2010 to 2019,” International Journal of Drug Policy 110 (December 2022). https://www.sciencedirect.com/science/article/pii/S0955395922002031; “Individuals Reporting Past Year Opioid Use Disorder,” Kaiser Family Foundation. https://www.kff.org/mental-health/state-indicator/past-year-opioid-use-disorder/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.
[4] “Provisional Drug Overdose Death Counts,” National Center for Health Statistics, Centers for Disease Control andPrevention, Feb. 1, 2026. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm.
[5] Ibid.
[6] Alison Athey et al., “An Overlooked Emergency: More Than One in Eight US Adults Have Had Their Lives Disrupted by Drug Overdose Deaths,” American Journal of Public Health, 114: 3 (March 2024). https://www.rand.org/pubs/external_publications/EP70412.html.
[7] Ron French, “Opioid crisis costs Michigan $38 billion in 2024, new analysis finds,” Michigan Health Watch, July 3, 2025. https://bridgemi.com/michigan-health-watch/opioid-crisis-cost-michigan-38-billion-2024-new-analysis-finds.
[8] “How effective are medications to treat opioid use disorder?” Medications to Treat Opioid Use Disorder Research Report, National Institute on Drug Abuse, December 2021. https://nida.nih.gov/research-topics/medications-opioid-use-disorder.
[9] “Drug Overdose and Substance Use,” Virginia Department of Health, Dec. 18, 2024. https://www.vdh.virginia.gov/drug-overdose-data; Stacey McKenna, “Drug Use 101: Physical Dependence and Withdrawal,” R Street Institute Explainer, Nov. 6, 2024. https://www.rstreet.org/research/drug-use-101-physical-dependence-and-withdrawal; Lev Facher, “Fentanyl isn’t just causing overdoses. It’s making it harder to start addiction treatment,” STAT, Nov. 16, 2022. https://www.statnews.com/2022/11/16/fentanyl-isnt-just-causing-overdoses-its-making-it-harder-to-start-addiction-treatment.
[10] Ibid.
[11] Ibid.
[12] “Only 1 in 5 U.S. adults with opioid use disorder received medications to treat it in 2021,” National Institute on Drug Abuse, Aug. 7, 2023. https://nida.nih.gov/news-events/news-releases/2023/08/only-1-in-5-us-adults-with-opioid-use-disorder-received-medications-to-treat-it-in-2021.
[13] Stacey McKenna, “How Red Tape Limits Access to Medications for Opioid Use Disorder,” R Street Institute Explainer, Nov. 7, 2023. https://www.rstreet.org/research/how-red-tape-limits-access-to-medications-for-opioid-use-disorder/.
[14] Chelsea Boyd, “Why Opioid Treatment Program Locations Matter,” R Street Institute Explainer, Oct. 14, 2025. https://www.rstreet.org/research/why-opioid-treatment-program-locations-matter; Opioid Treatment Program Directory, Substance Abuse and Mental Health Services Administration, Jan. 14, 2026. https://www.samhsa.gov/find-help/locators/opioid-treatment-program-directory?state=Michigan.
[15] Ibid.
[16] Abdullah Alibrahim et al., “Disparities in expected driving time to opioid treatment and treatment completion: findings from an exploratory study,” BMC Health Services Research, 22: 478, (2022). https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-022-07886-7.
[17] “Methadone Take-Home Flexibilities Extension Guidance,” Substance Abuse and Mental Health Services Administration, Nov. 6, 2024. https://www.samhsa.gov/substance-use/treatment/opioid-treatment-program/methadone-guidance; David Frank et al., “It’s Like ‘Liquid Handcuffs’: The Effects of Take-Home Dosing Policies on Methadone Maintenance Treatment (MMT) Patients’ Lives,” Harm Reduction Journal, 18: 88, (2021). https://doi.org/10.1186/s12954-021-00535-y.
[18] “Methadone Take-Home Flexibilities Extension Guidance,” Substance Abuse and Mental Health Services Administration, Nov. 6, 2024. https://www.samhsa.gov/substance-use/treatment/opioid-treatment-program/methadone-guidance; David Frank et al., “It’s Like ‘Liquid Handcuffs’: The Effects of Take-Home Dosing Policies on Methadone Maintenance Treatment (MMT) Patients’ Lives,” Harm Reduction Journal, 18: 88, (2021). https://doi.org/10.1186/s12954-021-00535-y.
[19] Brian Chan et al., “Mobile methadone medication units: A brief history, scoping review and research opportunity,” Journal of Substance Abuse Treatment, 129 (October 2021). https://www.sciencedirect.com/science/article/pii/S0740547221002099.
[20] Stacey McKenna, “Barriers to Opening an OTP,” R Street Institute Explainer, Sep. 3, 2025. https://www.rstreet.org/research/barriers-to-opening-an-otp; Sheri Doyle, “Overview of Opioid Treatment Program Regulations by State,” Pew Charitable Trusts Issue Brief, Sep. 19, 2022. https://www.pew.org/en/research-and-analysis/issue-briefs/2022/09/overview-of-opioid-treatment-program-regulations-by-state.
[21] Stacey McKenna, “To Improve Addiction Treatment, Give Opioid Treatment Programs Some Competition,” R Street Institute Analysis, Feb. 4, 2026. https://www.rstreet.org/commentary/to-improve-addiction-treatment-give-opioid-treatment-programs-some-competition; Doyle.
[22] Danielle Wood, “Drug diversion,” Australian Prescriber, 38:5 (Oct. 1, 2015). https://pmc.ncbi.nlm.nih.gov/articles/PMC4657309; Stacey McKenna, “Better Access to MOUD Reduces Diversion,” R Street Institute Analysis, Feb. 11, 2026. https://www.rstreet.org/commentary/better-access-to-moud-reduces-diversion.
[23] Theodore J. Cicero, et al., “Understanding the use of diverted buprenorphine,” Drug and Alcohol Dependence, 193 (Dec. 1, 2018). https://www.sciencedirect.com/science/article/pii/S0376871618307245; Magdalena Harris and Tim Rhodes, “Methadone diversion as a protective strategy: The harm reduction potential of ‘generous constraints,’” International Journal of Drug Policy, 24 (2013). https://www.researchgate.net/publication/233826245_Methadone_diversion_as_a_protective_strategy_The_harm_reduction_potential_of_'generous_constraints'.
[24] McKenna, “Better Access to MOUD Reduces Diversion.”
https://www.rstreet.org/commentary/better-access-to-moud-reduces-diversion.
[25] Krawczyk et al., Synthesizing evidence of COVID-19 regulatory changes on methadone treatment for opioid use disorder: implications for policy,” Lancet Public Health, 8:3 (Feb. 23, 2023). https://pmc.ncbi.nlm.nih.gov/articles/PMC9949855.