Methadone clinics in Texas: how opioid treatment programs work

If you or someone else might overdose, keep naloxone on hand: see free Narcan in Texas. In an emergency call 911; in a crisis call or text 988. SAMHSA's National Helpline, 1-800-662-4357, is free and open 24/7.

What a methadone clinic is

An opioid treatment program is the only place methadone can be dispensed for opioid use disorder; a doctor can't prescribe it for addiction at a pharmacy. Each Texas OTP needs four approvals:

Approval	From
OTP certification under 42 CFR Part 8	SAMHSA
Accreditation	A SAMHSA-approved accrediting body, such as CARF or the Joint Commission
Narcotic treatment program registration	The DEA, renewed every year
Narcotic treatment program license	Texas HHSC, under Health and Safety Code chapter 466 and 26 TAC chapter 563

OTPs can also dispense buprenorphine, and they must offer counseling and do drug testing under the federal standards.

Your first visit

1. Call ahead to ask about hours, intake times, what to bring and how they'll bill your coverage.
2. An exam and assessment by the clinic's medical staff: your opioid use, health, other medicines and pregnancy, with a drug test. Under the 2024 rule, the evaluation before methadone can be done by audio-visual telehealth when the practitioner decides that's adequate; buprenorphine can start after an audio-only or video evaluation.
3. A registry check. Texas OTPs use a central registry so no one is enrolled at two clinics at once (26 TAC 563.150).
4. Your first dose, taken at the clinic, then a dose adjusted over the following days and weeks.
5. A treatment plan with your counselor, reviewed as you go.

Daily dosing and take-home doses

At first you take each dose at the clinic. Take-home doses let you dose at home on some days. Under the 2024 federal rule (42 CFR 8.12), the clinic's practitioner can allow take-homes based on your progress and safety:

Time in treatment	Take-home doses allowed, at most
Days 1 to 14	Up to 7 days of take-homes
From day 15	Up to 14 days
From day 31	Up to 28 days

These are limits, not promises: the practitioner decides, with controls against diversion. States may set stricter rules, so ask the clinic how it applies Texas's rules in 26 TAC chapter 563.

What the 2024 federal rule changed

SAMHSA's rule "Medications for the Treatment of Opioid Use Disorder" was published February 2, 2024, took effect April 2, 2024, and required full compliance by October 2, 2024.

Topic	Before	Since 2024
Admission	At least a 1-year history of opioid addiction	The 1-year requirement is gone
Take-homes	Earned over months and years	Possible from the first week, on the practitioner's judgment
Telehealth	An in-person exam before starting	A remote evaluation can be enough: audio-visual for methadone
Counseling	Often a condition of getting your dose	Must be offered, but declining it doesn't bar you from medication

Cost and coverage

Coverage	What to know
Medicare	Since January 1, 2020, Medicare pays enrolled OTPs a weekly bundle that covers the medicine, counseling, therapy and drug testing. Ask the clinic whether it's enrolled.
Texas Medicaid	Texas Medicaid has enrolled OTPs since December 14, 2019. Medicaid members pay no copays. If you're in a Medicaid health plan, the clinic needs to be in its network: call the number on your card.
Private insurance	Coverage and what you pay vary by plan. Ask the plan whether the clinic is in network and whether you need prior authorization.
No insurance	Ask the clinic for its self-pay weekly fee and any sliding scale. For state-funded treatment, call 2-1-1 and ask for your regional OSAR. See free and state-funded rehab in Texas.

Clinics don't publish their fees on FindTreatment.gov or in the records we build from, so we don't show prices. Ask for the weekly fee in writing.

Methadone or buprenorphine?

Both treat opioid use disorder and lower the risk of overdose. The main practical differences:

• Where: methadone only at an OTP; buprenorphine from any prescriber with a DEA registration covering Schedule III, at a pharmacy, or at an OTP.
• Starting: buprenorphine usually means waiting for some withdrawal first; methadone doesn't.
• Structure: an OTP gives daily contact with a clinic, which some people want and others find hard around work.

Talk it through with a prescriber. See how to get Suboxone in Texas for buprenorphine.

Your rights in treatment

The Americans with Disabilities Act protects people in treatment for opioid use disorder, including people taking methadone or buprenorphine, the U.S. Department of Justice says. Its guidance covers employers, health care providers, treatment programs and state and local governments, among others: turning someone away only because they take prescribed medication for opioid use disorder may be disability discrimination. Looking for a home? Ask how a house handles medication before you move in: see sober living in Texas.

Find a clinic

• Cima Find Care's medication pages list Texas programs that offer medication for addiction (methadone, buprenorphine or naltrexone): Houston, Dallas, San Antonio, Austin, Fort Worth and El Paso. Call and ask whether they dispense methadone.
• SAMHSA's Opioid Treatment Program Directory lists certified OTPs by state.
• Medicaid members: Houston, Dallas and San Antonio programs offering medication that accept Medicaid.

City	MAT (medication)
Austin	10 programs, 6 take Medicaid
Dallas	18 programs, 15 take Medicaid
El Paso	5 programs, 4 take Medicaid
Fort Worth	7 programs, 4 take Medicaid
Houston	22 programs, 13 take Medicaid
San Antonio	14 programs, 10 take Medicaid