State reports rapid OTP growth and new fixed‑site rules, but zoning and funding limits slow rollout

The Health Care Authority’s State Opioid Treatment Authority told the advisory committee that Washington is expanding access to methadone through new regulatory pathways, but that local zoning confusion and recent budget proviso language have constrained how state funds can be used.

Jessica Blos, the state Opioid Treatment Authority, said Department of Health rule changes effective Jan. 31, 2025, now allow OTPs to register fixed‑site medication units and that mobile OTP medication units (vans or buses) and satellite clinics are additional options. “There are now, under federal law, a couple of different ways that you can have an opiate treatment program,” Blos said, distinguishing OTP medication units from buprenorphine prescribing settings.

Blos reported rapid growth in provider capacity: “We currently have 44 brick and mortar OTPs. This is a 51% growth since 2018,” she said, and added the state has 16 mobile treatment programs and 12 tribally owned OTPs — numbers she said are among the highest nationally. She estimated OTPs in Washington serve more than 19,500 people statewide.

Legal protections: Blos described statutory changes intended to reduce local zoning barriers by designating OTPs and their medication units as essential public facilities under state planning law. She cited the essential‑facility language discussed in the meeting (transcript reference to RCW for essential public facilities) and said her office coordinates with the state Attorney General’s civil‑rights team when local ordinances appear to treat OTPs differently from other health facilities.

Implementation challenges: despite the statutory language, Blos said some cities and counties apply extra scrutiny or misinterpret rules — at times treating OTP proposals as requiring more onerous review. The result, she said, has been a largely reactive approach in which state staff and the attorney general’s office intervene case‑by‑case rather than a fully proactive statewide education campaign for local elected officials.

Funding constraints: Blos told the committee that earlier plans to use opioid‑settlement and other state funds to pay capital costs for fixed‑site medication units were curtailed by a change in legislative proviso language. She said budget staff advised that current appropriations must be used to cover the non‑federal share of Medicaid services rather than capital construction, which forced HCA to pause some planned contracts to support fixed‑site expansion.

State support for rural access: Blos described targeted investments that have already funded new OTPs in rural areas through a competitive award process. She said the HCA and the Department of Commerce awarded contracts to build new sites — naming Acadia Healthcare and ORTC as awardees for Wenatchee and Walla Walla and a tribal award to a Suquamish entity — and that three additional fixed‑site medication units are in DOH review. She said some of the awards include requirements to maintain operations for a decade to preserve capacity created with one‑time funds.

Workforce and HR1 funds: Blos said Washington applied for federal HR1 rural health transformation funds and intends to dedicate a subset to OTPs to support workforce recruitment and retention in rural settings via a competitive bid process.

What’s next: staff asked the committee to consider whether it can help identify proactive strategies for community education and outreach to local jurisdictions and signaled continued coordination with the attorney general’s office to address zoning conflicts. The committee did not vote on any action; members encouraged staff to pursue proactive education to reduce ad‑hoc objections at the local level.