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Private equity's growing stake in methadone treatment clinics raises questions

March 19, 2024
Reporter, Morning Rounds Writer
Good morning. Here's something I didn't see coming. Private equity's ownership of hospitals and nursing homes has garnered attention over recent years. But now, in part 3 of the War on Recovery, Lev Facher reports on this form of for-profit ownership in another corner of U.S. health care: methadone clinics.

stat investigation

How private equity and profit motives figure into methadone treatmentScreenshot 2024-03-18 at 2.30.25 PM

Thumỹ Phan for STAT

In Part 1 and 2 of his War on Recovery investigation, Lev Facher has been telling us about the myths and stigma surrounding methadone and buprenorphine, two highly effective medications that curb opioid cravings and withdrawal and dramatically reduce the risk of a fatal overdose. Today he reports on the handful of little-known financial institutions that now hold an ownership stake in 562 methadone clinics across the country. 

Private equity ownership has cropped up in nearly one-third of U.S. methadone clinics in recent years, creating outsized control of the U.S. addiction treatment industry while the opioid epidemic has grown into a public health crisis. 

"We have the physicians of America on our side, and they have the MBAs of America on their side," said Sen. Ed Markey (D-Mass.) in response to STAT's findings. A critic of methadone clinics, Markey is co-author of a bipartisan bill that would allow trained addiction doctors to prescribe methadone directly to patients with opioid addiction. "They don't want to surrender the profits that come from having a monopoly."

There is no evidence that for-profit clinics offer lower-quality care, but the shift toward private-equity-backed treatment raises questions about methadone clinics' chief interests in the public policy debate — protecting profits or improving public health. The math is simple: When methadone clinics require patients to come in daily for their doses, the clinics typically make more money when patients also receive more services, like counseling, toxicology testing, and case management or care coordination services.

Medicare, for instance, pays clinics $259.80 each week for a bundle that includes medication dispensing, counseling, and drug testing. But Medicare pays just $40.71 for a week's worth of take-home medication. Read more.

The clinics push back, citing safety. "I don't think the dominant interest is just giving lots more take-homes to patients. There's more to treatment than that," Mark Parrino, founder and president of the American Association for the Treatment of Opioid Dependence, a nationwide advocacy group representing methadone clinics, told Lev in a Q&A. Read more.


rare disease

FDA approves gene therapy for a fatal neuron disease in children 

The FDA approved a gene therapy yesterday for metachromatic leukodystrophy, a devastating genetic disorder that eats away at affected children's neurons. Lenmeldy, the first treatment for the otherwise fatal disease, must be given before symptoms arise, or sometimes after the first signs of disease appear. When given early enough, it appears to be nearly curative, STAT's Jason Mast reports, allowing some children to grow up and attend school.

It's the same disease affecting a family that fled Afghanistan after the father helped U.S. soldiers there. Now living in Texas, they faced roadblocks to Medicaid coverage for their child, seeking the treatment under a "compassionate use" policy in Minnesota when the therapy was approved only in Europe, STAT's Megan Molteni told us. Some patients are identified after an older sibling falls sick, allowing doctors to screen and treat younger ones. Read more on the U.S. approval.



closer look

Opinion: We need to get the word out that eating before a colonoscopy is fineAdobeStock_593453441

Adobe 

The rising rate of colorectal cancer among younger people has lowered the age for a screening test to 45, down from 50. Improving detection means drawing attention to the best tool medicine has: the colonoscopy. If you just wrinkled your nose in disgust for the nasty prep, you're not alone. But gastroenterologist Benjamin Lebwohl says it doesn't have to be that way.

Imbibing that purgative drink is unavoidable, he writes in a STAT First Opinion, to give a clear view of the colon. But there's a second, unnecessary step: Most colonoscopy instructions insist on a clear liquids-only diet for the day before. "A low-residue diet, one that is heavy on starch and protein and free of vegetables, is just as effective," he says. "A pre-colonoscopy diet that includes solid foods is safe and effective, and there are abundant data to prove it." Read more.


public health

CDC alerts doctors to growing risk of measles

The CDC issued a health alert to physicians yesterday warning them of the rising risk of measles in this country. By March 14, the U.S. had racked up as many measles cases in 2024 as it had in the entirety of 2023 — 58 cases, reported by 17 states. In reality, the 2024 figure has already surpassed the 2023 total, with additional cases reported since the CDC's most recent update, STAT's Helen Branswell tells us.

The CDC said 93% of the cases were linked to international travel and most were in children who were not vaccinated. It urged doctors to ensure kids are up to date on their measles shots, and reminded them that those aged 6 months and 11 months who are embarking on international travel should receive a first dose of measles vaccine before they go. They should later receive two additional doses, after their first birthday. Typically kids get their first of two measles shot between the age of 12-to-15 months.

The American Medical Association's chief also weighed in. "As many Americans begin spring break travel, the AMA urges everyone who isn't vaccinated to get themselves and their families vaccinated against the measles," AMA President Jesse Ehrenfeld said in a statement.


health

'Havana syndrome' study finds no brain injury

The U.S. government calls them "anomalous health incidents," but most people think of them as Havana syndrome — the dizziness, visual difficulties, pain, and cognitive struggles first reported in 2015 by State Department workers posted at the U.S. Embassy in Cuba. Similar reports followed from other government officials stationed in Europe and Asia. Now a new JAMA study has found no brain injury on repeated scans in 81 patients with symptoms compared with 48 people in similar jobs but without symptoms.

In another JAMA study also published yesterday, these two groups showed few differences in auditory, vestibular, cognitive, and visual function tests or blood biomarker analyses. A companion editorial written by David Relman, who led an earlier study saying pulsed radio-frequency energy could cause the buzzing, high-pitched sounds the people reported, takes a skeptical view, drawing comparisons to dismissals of Gulf War syndrome, chronic fatigue syndrome, and long Covid. "Prejudice and poorly supported assumptions must be set aside," he writes. 


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  • DNA tests are uncovering the true prevalence of incest, The Atlantic

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  • EPA bans asbestos, a deadly carcinogen still in use decades after partial ban, Associated Press
  • Nearly 130,000 children exposed to lead-tainted drinking water in Chicago, The Guardian
  • 'It feels like a mountain you never get done climbing': Covid isn't over for disabled and older adults, The 19th 
  • Adam's Take: I was wrong about Geron's blood cancer drug. Now, is it a takeover target? STAT

Thanks for reading! More tomorrow,


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