Association for Public Policy Analysis & Management

There is a long held consensus among addiction experts that medication-assisted treatment using methadone (MAT-M) is the gold standard of opioid use disorder (OUD) treatment. However, research shows a glaring gap in access to treatment. MAT-M is one of the most regulated medical treatments in the US. Aside of federal law that restricts MAT-M to Opioid Treatment Programs (OTP) and regulates OTPs, all 51 states and the District of Columbia enacted MAT-M laws. Using a multilevel mixed effects regression model, empirical legal data from the Prescription Drug Abuse Policy System, and 2006-2016 opioid related mortality data from the Center for Disease Control WONDER datasets, we estimate the association between the restrictiveness of the state MAT-M law and the opioid drug overdose mortality in the state. The variable for the restrictiveness of the state law was constructed as a binary composite of 13 features of the MAT-M law. If the law was equal to the federal law on all 13 features, it was considered not restrictive—the federal law operates as floor preemption. Nineteen states and D.C. have law identical to the federal law while 31 states have a more restrictive law. We find that there is positive and statistically significant effect for state MAT-M restrictive law on opioid-overdose death rate per 100,000 people. This analysis is the first estimating the effect of law on access to MAT-M. It sheds light on the need of further research on the effect of other legal levers on MAT-M and other modes of MAT.