SAMHSA Cautions Against Long-Term Methadone and Buprenorphine Use While Trump Administration Explores Recovery-Focused Treatments and Alternatives

The Substance Abuse and Mental Health Services Administration issued a “Dear Colleague” letter in April 2026 cautioning against long-term use of methadone or buprenorphine for opioid addiction treatment. The letter stated that SAMHSA remains committed to expanding access to evidence-based treatment but also to ensuring medications serve as a pathway to long-term recovery rather than a default sentence to lifelong medication use.

Robert F. Kennedy Jr. took office as Secretary of Health and Human Services in February 2025 and is the first health secretary openly in recovery from addiction to drugs and alcohol. At the Rx Summit in Nashville in April 2025, Kennedy said the country needs Suboxone, methadone, naltrexone, and Narcan as practical components of its response to the overdose crisis.

Michael Stuart, a former West Virginia state lawmaker who introduced legislation to ban methadone treatment, was appointed top Health and Human Services lawyer one year before the April 2026 letter. Stuart was confirmed in October 2025 as HHS general counsel and co-authored a bill to outlaw methadone clinics in West Virginia that was introduced in early 2024 but did not advance.

He was recently reassigned to an unknown role within HHS after reporting that he invested in the stock of a major federal contractor.

Rep. ) introduced legislation in September 2025 that would require patients to visit methadone clinics in person every day during the first months of treatment, re-impose a requirement that patients must have been addicted to opioids for over a year before seeking methadone, and bar doctors from evaluating patients seeking methadone or buprenorphine via telehealth.

The bill has not gained any co-sponsors or a hearing in the House Energy and Commerce Committee.

A coalition including the American Society of Addiction Medicine and the American Academy of Family Physicians wrote in a March 2026 letter that the Houchin bill, if enacted as drafted, would result in more opioid overdoses. Yngvild Olsen, who served as director of SAMHSA’s Center for Substance Abuse Treatment until early 2025, said turning clinical care into policy is fraught and that the winds have shifted away from evidence-based engagement toward punitive and public safety approaches.

David Fiellin, director of the Yale Program in Addiction Medicine, said observational and experimental studies show patients do better the longer medications are continued, though robust evidence beyond two years is limited.

Olsen said some patients might need to stay on methadone or buprenorphine for life, similar to insulin for diabetes or statins for high cholesterol. Methadone, buprenorphine, and naltrexone are the only three drugs approved by the Food and Drug Administration specifically to treat opioid addiction.

People who use methadone or buprenorphine are more than 50% less likely to die of a drug overdose, according to the medical, public health, and drug policy communities.

Methadone remains available only at specialized clinics that often require multiple early morning visits per week, frequent drug testing, and counseling. Overdose deaths have plummeted since 2022 and recently dipped below 70,000 annually for the first time since 2019.

The Trump administration has expressed interest in psychedelics such as ibogaine and in GLP-1 medications such as Ozempic or Wegovy as potential addiction treatments.