In February 2020, Admiral Brett Giroir, the U.S. Department of Health and Human Services (HHS) Assistant Secretary for Health, delivered a strong message at the CMS Quality Conference in Baltimore: the lack of access to medication-assisted treatment (MAT) in residential facilities is “absolutely unacceptable.” His comments shed light on both the progress made and the glaring gaps that remain in the fight against opioid use disorder (OUD) and the resurgence of methamphetamine use in America.
This moment reflects a pivotal turning point for addiction treatment, where science, policy, and public health must align to ensure patients receive the evidence-based care they deserve.
The Progress of MAT Expansion
Over the last decade, medication-assisted treatment has become widely recognized as the “gold standard” for treating OUD. Unlike abstinence-only approaches, MAT combines FDA-approved medications—such as buprenorphine, methadone, and naltrexone—with counseling and behavioral therapies. Studies consistently show that MAT helps patients stay in treatment longer, reduces the risk of relapse, and lowers the likelihood of overdose.
Since January 2017, the number of providers eligible to prescribe MAT has doubled, thanks in part to the Comprehensive Addiction and Recovery Act (CARA) of 2017. This landmark legislation expanded buprenorphine waiver eligibility to nurse practitioners (NPs) and physician assistants (PAs), greatly increasing the treatment workforce.
Today, more than 111,000 providers are authorized to treat approximately 6.3 million patients. Federal grants and initiatives have further fueled this growth, providing resources to states, treatment programs, and community organizations.
Admiral Giroir praised these advancements, recognizing them as a major step toward addressing the opioid epidemic. Yet, despite the progress, he was clear: far too many people remain without access to lifesaving MAT.
The Gap in Residential Treatment
One of the most alarming issues is the lack of MAT availability in residential treatment facilities. According to HHS, of the roughly 3,000 residential programs nationwide, only 40% currently offer MAT. That means the majority—about 60%—do not provide this evidence-based treatment.
For Giroir, this is unacceptable:
“MAT is the standard of care. It may not be for every single individual, but it’s for most individuals, and we need to absolutely improve. MAT needs to be offered to everyone who is in an opioid treatment program.”
The consequences of this shortfall are staggering. At present, about 1.3 million people nationwide are receiving MAT, while an estimated two million people live with OUD. This treatment gap leaves hundreds of thousands of Americans at risk of relapse, overdose, and death—despite being engaged with treatment systems that should be able to help them.
Barriers to MAT Access
While CARA and other federal initiatives have helped expand MAT, barriers remain. State-level scope-of-practice laws often restrict nurse practitioners and physician assistants, limiting the tasks they can perform—even when they are trained and willing to prescribe MAT. These regulations vary widely, meaning access to treatment often depends on geography rather than medical need.
Additionally, some treatment programs remain resistant to MAT due to stigma, philosophical differences, or outdated views that equate recovery with abstinence from all medications. This resistance persists despite overwhelming scientific evidence showing that MAT saves lives.
Insurance hurdles also play a role. In many cases, insurers require prior authorization for MAT medications or limit coverage, creating unnecessary delays for patients in crisis.
Federal Efforts to Expand Access
To address these challenges, HHS has launched several initiatives aimed at expanding MAT availability. One area of focus is integrating MAT into emergency rooms (ERs), which often serve as the first point of contact for individuals experiencing overdoses or withdrawal. By connecting patients with MAT directly in the ER, providers can bridge a critical gap in the continuum of care.
“CMS is helping to support that with potential new codes,” Giroir noted, pointing to changes that would make it easier for hospitals and providers to bill for MAT-related services.
Additionally, federal grants continue to support training programs, expand provider capacity, and strengthen local treatment networks. However, as Giroir emphasized, the work is far from complete.
The Methamphetamine Resurgence
While the opioid epidemic has dominated headlines, another crisis has been growing in the shadows: methamphetamine use. Meth-related deaths have surged in recent years, particularly in the western United States.
In 2017, meth accounted for more overdose deaths than opioids such as fentanyl in certain regions. By late 2019, meth-related deaths had overtaken those from prescription opioids and heroin, and projections suggested meth would soon surpass cocaine as well.
“Methamphetamine deaths six months ago overtook [deaths from] prescription opioids,” Giroir said. “Last month it overtook heroin, and it will overtake cocaine within the next month or two. It is at the top of my list to directly address the resurgence of this, to support regions with rising mortality [and] to treat this like a real epidemic with real time public health interventions.”
Unlike opioids, there are currently no FDA-approved medications for treating methamphetamine use disorder. Treatment relies heavily on behavioral therapies, such as contingency management and cognitive behavioral therapy, which can be effective but are not always widely available or reimbursed.
The rise in meth use underscores the need for investment in research, innovative treatment approaches, and expanded public health infrastructure.
Why MAT in Residential Settings Matters
The absence of MAT in residential programs is particularly concerning given the role these facilities play in treating severe cases of substance use disorder. Patients entering residential treatment are often at higher risk due to long histories of use, co-occurring disorders, or previous treatment failures.
Without MAT, many of these individuals face heightened risks of relapse after discharge. Research shows that individuals who do not receive MAT after residential treatment are more likely to return to opioid use and face overdose risks, especially in the vulnerable period immediately after leaving a structured environment.
By integrating MAT into residential programs, providers can deliver comprehensive, evidence-based care that supports long-term recovery while reducing the risk of fatal outcomes.
Looking Ahead
Admiral Giroir’s remarks highlight the urgency of addressing both the opioid epidemic and the growing meth crisis. Expanding MAT access, particularly in residential facilities, is essential to closing the treatment gap and ensuring patients receive the best possible care.
At the same time, methamphetamine’s resurgence demands new research, stronger public health interventions, and innovative approaches to treatment. Policymakers, providers, and communities must work together to confront these dual challenges with urgency and compassion.
The road ahead is not easy. Barriers such as stigma, restrictive state laws, and limited insurance coverage continue to slow progress. But the momentum is building, and with strong leadership and evidence-based strategies, the addiction treatment landscape can—and must—evolve.
As Giroir made clear, anything less than full access to effective treatment is unacceptable. For the millions of Americans struggling with substance use disorder, the stakes could not be higher.
