Despite sweeping bipartisan legislation aimed at combating the opioid crisis and cracking down on unethical practices in addiction treatment, the Department of Justice (DOJ) has yet to prosecute a single body-brokering case since the law’s passage in 2018. This revelation raises questions about enforcement and the ongoing integrity of the addiction treatment industry.
Body brokering, also known as patient brokering, involves individuals—referred to as body brokers—who actively seek out people with substance use disorders (SUDs) and refer them to treatment centers in exchange for a financial kickback. These brokers often use gifts, perks, or other incentives to persuade patients to enter treatment programs. Such practices exploit vulnerable individuals and undermine the goal of providing effective care for opioid use disorder (OUD) and other addictions.
The SUPPORT Act and Its Intentions
In October 2018, President Trump signed the SUPPORT for Patients and Communities Act (SUPPORT Act) into law, a wide-ranging piece of legislation targeting the nation’s opioid epidemic. Among its many provisions was the criminalization of patient brokering. The law explicitly prohibits anyone from offering, giving, soliciting, or receiving any remuneration to induce patient referrals for substance use disorder treatment. Violations of this law carry severe penalties, including up to 10 years in prison.
The SUPPORT Act was intended not only to expand access to treatment but also to ensure that patients are referred to legitimate providers who genuinely prioritize recovery over profit. Unfortunately, while the legislation has been in effect for nearly two years, the DOJ has not pursued a single case. In a letter responding to congressional inquiries, DOJ Assistant Attorney General Stephen E. Boyd confirmed that no prosecutions had been initiated.
Why Enforcement Matters
The lack of enforcement is significant because body brokering continues to pose a major threat to patient safety and the integrity of the addiction treatment market. Providers engaged in body brokering may prioritize revenue over recovery, sometimes putting patients at serious risk.
For instance, some unethical facilities may give patients controlled substances to ensure they fail drug tests, or purchase expensive insurance policies for patients to maximize reimbursements, only to discharge them when their treatment is no longer profitable. These practices not only exploit patients but also inflate healthcare costs and undermine public trust in behavioral health services.
The Size of the Addiction Treatment Market
The U.S. addiction treatment industry has grown rapidly over the past decade, with current estimates valuing the market at around $42 billion and encompassing more than 15,000 providers. This rapid expansion has created opportunities for unscrupulous operators to engage in unethical practices, including patient brokering.
The revolving door between detox centers, treatment facilities, and sober living homes has become a lucrative system for operators who understand how to manipulate the system. According to the Orange County Register, some providers have built extensive networks that exploit patients while generating significant profits.
Congressional Concerns
Congressional lawmakers have expressed concern about the DOJ’s lack of enforcement. In a letter sent months after the SUPPORT Act was signed, several members asked the DOJ for information on how many body-brokering cases had been pursued. The DOJ’s response—confirming zero prosecutions—highlighted the gap between legislation and enforcement.
The lawmakers’ inquiries reflect a broader frustration within the public and professional communities about the slow response to unethical practices in the behavioral health sector. They emphasize the need for vigilance and proactive measures to ensure patients are protected.
DOJ’s Response
In its letter, the DOJ acknowledged the newness of the law and indicated that the department takes the investigation and prosecution of illegal practices seriously. Boyd noted that violations of the body brokering provisions carry significant penalties and that the DOJ will consider charging violations in appropriate cases. However, he also indicated that enforcement may take time given the law’s relative novelty and the complexities involved in identifying and prosecuting cases.
While this explanation provides some context, it does not diminish concerns that patients continue to be at risk and that the industry remains vulnerable to exploitation. Many advocates argue that aggressive enforcement is essential to deter unethical operators and protect the integrity of addiction treatment services.
The Impact on Patients
Patients affected by body brokering face numerous risks. Those referred to facilities primarily motivated by profit may receive substandard care, experience premature discharges, or be subjected to unnecessary medical procedures. Such experiences can hinder recovery and exacerbate mental health and substance use challenges.
Moreover, the psychological toll on patients who are exploited or manipulated can be significant. Vulnerable individuals seeking help for addiction deserve ethical, evidence-based care, and violations of patient trust can have long-lasting effects on recovery outcomes.
Industry Implications
The DOJ’s lack of prosecutions also has broader implications for the addiction treatment industry. Without active enforcement, unethical practices may continue to proliferate, undermining the credibility of legitimate providers and creating a competitive disadvantage for organizations committed to patient-centered care.
For providers operating ethically, the presence of body brokers and unscrupulous facilities can distort the market and make it harder to compete. It also complicates efforts to build trust with patients and families, who may be skeptical about the motives of treatment programs.
Looking Forward
While the SUPPORT Act was a landmark legislative effort, its effectiveness ultimately depends on enforcement. Advocates argue that the DOJ must prioritize investigations into body brokering to protect patients and uphold the law’s intent.
In the meantime, industry leaders and professional organizations continue to call for heightened awareness and proactive measures to combat patient brokering. This includes thorough vetting of treatment facilities, transparent referral practices, and reporting suspicious activity to authorities.
Conclusion
The SUPPORT Act represented a major step forward in the fight against the opioid epidemic and unethical practices in the addiction treatment industry. However, the DOJ’s failure to prosecute any body-brokering cases since the law’s passage underscores a critical gap between legislation and enforcement.
Patients remain vulnerable to exploitation, and the integrity of the addiction treatment market is at stake. Aggressive enforcement, combined with increased oversight and industry accountability, is essential to ensure that individuals seeking help for substance use disorders receive ethical, high-quality care.
The road ahead will require cooperation among lawmakers, regulators, and industry leaders to ensure that body brokering is not only illegal on paper but actively deterred in practice. Until that happens, patients, families, and ethical providers may continue to bear the consequences of inaction.
The SUPPORT Act remains a critical tool, but its promise can only be realized if the DOJ and other authorities commit to enforcing the law and protecting those who need treatment the most.
