April is the deadline. May could be the rollback. SAMHSA’s OTP rule and the H.R. 5629 fight, explained.

This month marks the first hard compliance deadline for the most significant update to U.S. opioid treatment program (OTP) regulation in more than twenty years. The SAMHSA final rule, published in February 2024 in the Federal Register, raises the maximum initial methadone dose from 30 mg to 50 mg (important for patients with high fentanyl tolerance), makes COVID-era take-home flexibilities permanent (up to 28 days after the first month of treatment), and integrates harm reduction principles into routine OTP practice — including naloxone distribution and fentanyl/xylazine test strip access.

At the same time, the House Energy and Commerce Subcommittee on Health is reviewing H.R. 5629, which would nullify the rule. The Pew Charitable Trusts submitted testimony on April 7 arguing that the bill would erase three specific gains: expanded take-home methadone in early treatment, telehealth-based admission for methadone and buprenorphine, and dose-splitting flexibility for high-acuity patients. Pew cites studies showing these flexibilities reduced travel burden and kept people in treatment without measurable increases in diversion.

Why this matters for people in recovery

The practical impact lands at the program level: every OTP in Arizona is operationally restructuring this month to meet the new rule. If H.R. 5629 advances, some of those same programs will have to restructure again. For patients, the simplest takeaway is to ask your program directly about take-home eligibility and telehealth options — both are explicitly preserved under current federal law as of today, but the policy environment is shifting in real time.

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