Every Methadone Clinic in Montana Now Belongs to One Company

Montana has four places where a person can walk in and legally receive methadone for an opioid use disorder. Every one of them is operated by the same company.

That is not a reporter's impression. It is what two separate federal files say. In the Medicare enrollment data that CMS posted on October 26, 2026, Montana contains four opioid treatment program records — Missoula, Kalispell, Billings and Belgrade — and all four carry the same provider name: Community Medical Services Montana. SAMHSA's own treatment directory returns the same answer: four certified programs in the state, all branded Community Medical Services, certified in 2010, 2011, 2014 and 2017 respectively. Nothing has been certified in Montana in the nine years since.

The arrangement drew national attention this week. In an analysis first published by The Conversation on October 28 and reprinted by Fortune on October 30 under the headline "One private equity–backed company owns every methadone clinic in Montana," Brown University health economist Yashaswini Singh documented how financial firms came to control a large share of the country's methadone supply — and found that Montana sits at the far end of that trend.

One organization, every enrollment

Montana is close to unique. Running the CMS file myself, two states are the only ones in the country where a single organization holds every Medicare-enrolled opioid treatment program in the state: Montana, with four, and South Dakota, with one. Everywhere else, at least two owners compete for patients.

The records also show how little the public file reveals about ownership. The legal entity named "Community Medical Services Montana" appears on 19 enrollment records — four in Montana, six in Colorado, three in North Dakota, two in Minnesota, two in Alaska and two in Oregon. A patient in Westminster, Colorado, is enrolled under a company whose name says Montana.

And the neighboring state is starker still. SAMHSA's directory returns no certified opioid treatment program for Wyoming at all, and the CMS file contains no Wyoming enrollment record. For a person in Sheridan or Cody who needs methadone rather than buprenorphine, the nearest program is likely in another state.

That matters because methadone is not dispensed like other prescriptions. Under federal rules it can be provided for opioid use disorder only through a certified opioid treatment program, which is why these clinics are the single door to the medication in most of the country. Singh's analysis puts private equity ownership at roughly 35% of opioid treatment providers nationally, and above half in 19 states and the District of Columbia. A second paper, published in the International Journal of Drug Policy in May 2026, describes the same consolidation as a consequence of regulation itself: a "complex federal regulatory regime and public-financing expansions that create barriers for smaller providers and predictable revenue streams for PE-owned facilities."

What the research actually measured

The strongest evidence on what acquisitions do is not an opinion. It is a difference-in-differences study Singh co-authored with researchers at RAND and the University of Pittsburgh, published in Health Affairs in September 2025, covering every private equity acquisition of an opioid treatment program from 2006 through 2019 and matching it against methadone shipment data.

The headline finding is about market structure. In the median county that saw any acquisition at all, private equity firms wound up holding 67% of the opioid treatment market — usually through a series of small purchases rather than one big one. Methadone shipments to the acquired clinics rose 13% relative to matched controls, but that difference did not survive adjustment for pre-existing trends. County-level methadone shipments and opioid overdose mortality were unchanged.

In plain terms: the firms bought the capacity that already existed. They did not visibly build more of it. The authors' conclusion was that acquisitions "may consolidate ownership of OTPs among financial investors without changing methadone supply."

The 2026 commentary in the International Journal of Drug Policy is blunter about the mechanisms to watch, naming understaffing, revenue optimization and attempts to shape regulation as the risks that follow ownership change in this sector. The authors do not claim proven patient harm. They describe a state with four clinics and one owner as worth watching rather than assuming.

What it looks like at 5 a.m.

Singh's reporting opens with Amber Titus, 38, who drives 45 minutes each way from Bisbee Junction, Arizona, to the Community Medical Services clinic in Sierra Vista — a clinic that, according to the CMS file, is still operating at 302 El Camino Real. She goes three times a week, sometimes with a one-year-old in the car seat. When her car was totaled in August and Medicaid-arranged rides arrived late, she told Singh, she missed a week of doses.

Arizona is also the state CDC singled out in May, when it reported that overdose deaths nationally fell almost 14% in 2025 to 69,973 while New Mexico, Arizona and Colorado rose by 10% or more. Opioid-involved deaths nationally fell to 44,564 from 55,296. Montana was not among the states flagged for an increase, which is precisely the argument for keeping the four programs it has running.

Distance is the part families underestimate, and it is the part that clinic policy controls more than people realize.

The rule changed; the schedule often did not

Federal regulation was rewritten to make daily attendance optional in many cases. Under 42 CFR § 8.12(i), a program's medical director may authorize take-home doses based on clinical criteria rather than a fixed calendar: up to 7 days during the first 14 days of treatment, up to 14 days from day 15, and up to 28 days from day 31, with the rationale documented in the patient's record.

That means a patient who is stable at three months is not federally required to appear every morning. Whether they still must is a program decision. The regulation also retains an interim-treatment pathway for people who cannot reach comprehensive services "within a reasonable geographic area," which is written for exactly the rural situation Montana presents.

If you are deciding whether a daily drive is avoidable, ask the clinic directly and in writing. Our family guide to methadone clinics walks through the intake visit, guest dosing and what the take-home tiers mean in practice, and this guide to medication-assisted treatment covers how methadone compares with buprenorphine if travel is the deciding factor.

What to ask before you enroll

• Will you evaluate me for take-home doses at 15 days and again at 31 days, and what specifically would disqualify me?
• What are your dosing hours, and what happens if I arrive ten minutes after the window closes?
• Do you accept Montana Medicaid, and what is the monthly cost if I am uninsured? (Finding treatment without insurance covers the assistance programs.)
• Who is the corporate owner, and where do I file a grievance that is not handled by that same company?
• If I move or travel, will you arrange guest dosing, and how much notice do you need?

What happens next in Washington

The policy fight that would change this picture is already filed. H.R. 9790, the Modernizing Opioid Treatment Access Act 2.0 of 2026, introduced by Rep. Donald Norcross (D-N.J.) on July 20, 2026, would let qualified physicians prescribe methadone and pharmacies dispense it, ending the clinic-only model that gives any single operator regional leverage. Congress.gov shows the bill referred to the Energy and Commerce and Judiciary committees and still at the introduced stage, with no markup scheduled; the current Congress ends in January 2027.

Singh also reports that Sen. Maggie Hassan (D-N.H.) has opened an investigation into three of the largest methadone clinic operators, questioning whether they oppose wider access for financial reasons rather than safety ones. That inquiry, not the bill, is the nearer-term event for Montana patients.

In the meantime, the practical arithmetic has not changed. Four programs, one owner, and a state where the newest clinic was certified in 2017. New capacity in rural America costs money that volumes in places like Kalispell do not recover — Singh quotes Community Medical Services chief executive Nick Stavros putting a new clinic at about $2.5 million, and reporting that in 2018 an outside investor advised closing the company's Montana and North Dakota sites as unprofitable before the company instead took private equity backing to keep them open.

That is the honest version of the trade-off. The clinics exist because someone financed them. The question worth asking is what patients get for the arrangement — and whether anything changes when the only alternative is a day of driving.

If you or someone in your household needs help now, the SAMHSA National Helpline is 1-800-662-4357, available 24 hours a day in English and Spanish, and the 988 Suicide and Crisis Lifeline can be reached by call or text.