Private Equity Acquisition Of Addiction Treatment Facilities Linked To Higher Buprenorphine Use, Lower Treatment Retention

March 24, 2026

At addiction treatment facilities acquired by private equity, the number of people with opioid use disorder (OUD) receiving buprenorphine increased, according to a recent comparison. However, the duration of treatment retention related to buprenorphine prescribing decreased.

The analysis included 90 addiction treatment facilities acquired by private equity from the third quarter of 2019 through the second quarter of 2021. The comparison group included 2,374 facilities that were not owned by private equity investors. The researchers analyzed differences in the number of people with OUD being treated with buprenorphine and treatment retention measures.

Private equity acquisition was associated with an average increase of 65.6 additional people receiving buprenorphine per facility per quarter, representing a nearly 22% increase from baseline. At baseline, acquired facilities had higher average patient volume (302.91 per quarter) compared to 72.04 at non-acquired facilities.

The number of buprenorphine prescriptions at the acquired facilities increased by an average of 163.9 per facility per quarter, representing more than a 19% increase from baseline. At baseline, prescription volume at acquired facilities averaged 841.49 per quarter, compared to 289.05 at non-acquired facilities.

After private equity acquisition, the share of buprenorphine prescriptions paid in cash increased by 0.73 percentage points. At baseline, 4.78% of prescriptions at acquired facilities were paid in cash, compared to 8.81% at non-acquired facilities.

Treatment episodes of 180 days or longer are a national performance measure. Early discontinuation is associated with increased risks of relapse and mortality the researchers stated.

Treatment episode duration decreased at acquired facilities relative to those that had not been acquired by private equity. The share of individuals remaining in treatment for 90 days declined by 6.24 percentage points, and the share of treatment episodes lasting 180 days declined by 7.91 percentage points.

The researchers concluded that in areas with high unmet need, having higher volumes of people entering treatment could lead to improved outcomes at a population level, even if 180-day retention is lower. The apparent quality-quantity tradeoff of the facilities acquired by private equity could be beneficial.

These findings were reported in Private Equity Acquisition and Buprenorphine Prescribing by Taylor Holdaway, Ph.D.; Susan H. Busch, Ph.D.; Jackson Reimer, BS; and colleagues. The researchers identified facilities acquired by private equity from 2013 to 2023 using data from Irving Levin Associates Health Care M&A and data from PitchBook. For the control group of non-acquired facilities, the researchers analyzed the National Survey of Substance Abuse Treatment Services (N-SSATS) from 2019 to 2021. The facilities identified in the N-SSATS were privately owned; the researchers excluded facilities owned by the federal Department of Veterans Affairs or other entities. In a sensitivity analysis, they restricted the control group to private, for-profit facilities. The researchers linked prescribers to facilities using physician registry data.

To examine prescribing patterns, they analyzed the LRx database containing individual prescription fills of buprenorphine. The researchers grouped prescription payment data into four categories: Medicaid (including Medicaid managed care and fee-for-service Medicaid), Medicare Part D, third-party insurance, and cash. Third-party insurance included private and commercial insurance, including plans purchased on health insurance exchanges, employer-sponsored plans, state and federal assistance programs, discount cards, vouchers, and unspecified or unknown third-party payers. The cash category was composed of self-pay.

The full text of Private Equity Acquisition and Buprenorphine Prescribing was published on March 2, 2026, by JAMA Network Open. A free copy is available (accessed March 18, 2026).

For more information, contact: Taylor Holdaway, Ph.D., The Wharton School, University of Pennsylvania, 3641 Locust Walk, Philadelphia, Pennsylvania 19104; Email: thold@upenn.edu; Website: https://www.wharton.upenn.edu/