SAMHSA Letter Urges Medications for Opioid Addiction as Pathway to Recovery, Not Lifelong Use

The Substance Abuse and Mental Health Services Administration issued a Dear Colleague letter in April that cautioned against long-term use of methadone or buprenorphine. The letter stated that SAMHSA remains committed to expanding access to evidence-based treatment, including medications, but added that medications should serve as part of a pathway to long-term recovery and sobriety rather than a default sentence to lifelong medication use.

Robert F. Kennedy Jr. took office as health secretary in February 2025. At the Rx Summit in Nashville in April 2025, he told attendees that the country needed Suboxone, methadone, naltrexone, and Narcan as practical components of its response to the overdose crisis.

A year before the SAMHSA letter, the Trump administration appointed Michael Stuart, a former West Virginia state lawmaker who had introduced legislation to ban methadone treatment, as the top Health and Human Services lawyer. Stuart was confirmed in October 2025 as HHS general counsel and was later reassigned to an unknown role within the department after NOTUS reported that he had invested in the stock of a major federal contractor.

In September, Rep.

) introduced legislation that would roll back 2024 SAMHSA flexibilities for methadone treatment. The bill would require patients to visit methadone clinics in person every day during their 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.

A coalition that includes 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 and oversaw the rewrite of regulations to make methadone treatment more accessible, said the purpose of the April letter remained unclear. She stated that if the letter meant everyone who starts on one of these medications should at some point come off, that position would not be consistent with best practice, clinical guidelines, or the evidence.

David Fiellin, director of the Yale Program in Addiction Medicine, said observational and experimental studies have shown that patients do better the longer medications are continued.

He noted that robust evidence beyond two years is limited but that outcomes remain best during the period patients stay on medication. Methadone, buprenorphine, and naltrexone are the only three drugs approved by the FDA specifically to treat opioid addiction. People who use methadone or buprenorphine to treat opioid addiction are more than 50% less likely to die of a drug overdose.

Overdose deaths have plummeted since 2022 and recently dipped below 70,000 annually for the first time since 2019. The Trump administration has expressed significant interest in turning to ibogaine as a potential addiction medication. Former Trump health secretary Tom Price said in 2017 that methadone and buprenorphine are just substituting one drug for another.

U.S. has long treated these medications with suspicion compared with other wealthy countries. Olsen said turning clinical care into policy is fraught and that the winds have shifted away from evidence-based ways of engaging people who use drugs and toward punitive and public safety approaches.