A new analysis from the U.S. Department of Health and Human Services’ Office of the Inspector General finds that Medicare and Medicaid enrollees in many high-needs areas of the country — including several counties in Arkansas — lack access to medications for opioid use disorder (MOUD).

Background

The U.S. Food and Drug Administration has approved three drugs used in MOUD: buprenorphine, methadone, and naltrexone. Buprenorphine is a controlled substance accessible through office-based buprenorphine providers (e.g., primary care providers) and opioid treatment programs. Methadone is also a controlled substance that reduces opioid cravings and withdrawal by blunting or blocking the effects of opioids. Methadone can only be administered or dispensed by opioid treatment programs certified by the Substance Abuse Mental Health Services Administration (SAMSHA) in an outpatient setting, and patients are usually required to visit programs daily to receive their methadone dose. However, federal regulations were amended in 2024 to allow certain patients to have up to 28 take-home doses provided to them. Naltrexone is not a controlled substance and can be prescribed by any qualified healthcare provider, but requires seven to 14 days of opioid abstinence before it can be initiated and has lower rates of medication adherence.

A law passed by Congress in 2020 added opioid treatment program coverage requirements to Medicare and requires that state Medicaid programs cover all forms of MOUD treatment. The law also expanded coverage for Medicare enrollees to include MOUD services provided by an opioid treatment center and waived cost sharing for these services.

The Office of the Inspector General notes that previous work found that many Medicare and Medicaid enrollees with opioid use disorder did not receive MOUD through these programs. While access to these programs has been expanded, this analysis focused on providers and the extent to which they prescribed or administered MOUD services and whether they were located in high-need areas. The report also includes a companion product with interactive maps using county- and state-level data. The maps below highlight findings specific to MOUD providers and treatment availability in Arkansas.  

Key Findings

• In 2022, 19% of U.S. counties did not have a single MOUD provider, including more than 100 counties with high needs for MOUD services. This includes 14 Arkansas counties, as shown in Figure 1 below. Additionally, more than one-quarter of high-need counties in the U.S. had few or no MOUD providers, including 27 counties in Arkansas (see Figure 1).