Breaking Down Barriers: How Prince George’s County Is Expanding Access to Opioid Treatment
An Epidemic Demanding Action
Prince George’s County faces a serious and persistent opioid crisis. The county records more than one overdose daily, reflecting the severity of substance use disorder affecting residents across the region. Between 2017 and 2021, Prince George’s County accounted for 5.73 percent of all opioid-related deaths in Maryland, averaging 129.4 deaths annually—representing a 35.48 percent increase from the beginning to the end of that period.​
The crisis disproportionately affects Black residents. From 2017 to 2021, non-Hispanic Black Marylanders made up 64.36 percent of total opioid-related deaths in Prince George’s County, while representing only a portion of the county’s population. Nationally, racial disparities in opioid mortality have widened significantly, with Black males 1.5 times more likely to die from opioid overdose than White males. In Prince George’s County specifically, a majority Black jurisdiction, there was a 135.1 percent increase in opioid-related fatalities in the first half of 2020 alone.​
These disparities persist not by chance, but by design—rooted in systemic barriers to treatment access, healthcare inequities, and inadequate resources for underserved communities. Among the most significant barriers are zoning restrictions that prevent treatment facilities from operating in many neighborhoods, effectively creating deserts where residents cannot access care.
Understanding Medication-Assisted Treatment
For individuals struggling with opioid use disorder (OUD), medication-assisted treatment represents a gold-standard, evidence-based approach to recovery. MAT combines FDA-approved medications with counseling and behavioral therapies to address both the physical and psychological aspects of addiction.
Three medications have been approved by the FDA for treating OUD: methadone, buprenorphine, and naltrexone. Methadone and buprenorphine work by reducing cravings and preventing withdrawal symptoms, allowing individuals to function without the constant cycle of craving and withdrawal that characterizes active addiction. The evidence supporting these medications is clear and decades-long: people with OUD taking prescribed methadone or buprenorphine are 50 percent less likely to die from overdose compared to those receiving no treatment.​
Despite this overwhelming evidence, only a small percentage of Americans with opioid use disorder receive medication-based treatment. Nationally, only 55.2% of adults with opioid use disorder received any treatment in 2022, and just 25.1% received medications for opioid use disorder, according to CDC data.​
The Access Crisis in Prince George’s County
Prince George’s County faces a peculiar problem: while the need for treatment is clear and urgent, the infrastructure to deliver care remains inadequate and geographically fragmented. According to Maryland state data, Prince George’s County had a need rate of 6.4 individuals per 1,000 residents requiring opioid treatment services. While this rate is lower than some other Maryland counties, the absolute number of residents needing treatment remains substantial given the county’s large population.​
What makes Prince George’s County’s situation particularly challenging is that treatment capacity has been constrained by restrictive zoning regulations. Historically, methadone treatment centers were classified as a separate principal use type in the county’s zoning code, with stringent restrictions limiting where these facilities could be located. This regulatory approach—common in many jurisdictions—effectively stigmatized treatment facilities and prevented them from operating in many neighborhoods, even where residents desperately needed access.​
These zoning barriers reflect a broader pattern of exclusion. Communities have historically resisted locating substance use treatment facilities in their neighborhoods, driven by stigma, misconceptions about patients, and concerns about neighborhood character. Yet this NIMBY (Not In My Backyard) approach has devastating public health consequences: it concentrates treatment facilities in limited areas, creates long travel distances for patients, and perpetuates the invisibility of the crisis in affluent neighborhoods.
Addressing Systemic Barriers
Research on medication-assisted treatment access reveals multiple overlapping barriers preventing broader uptake, including stigma among healthcare providers, inadequate professional training, fragmentation between addiction treatment and mainstream medical care, insurance coverage gaps, and regulatory barriers like restrictive zoning. In Prince George’s County, the regulatory barrier has been particularly consequential because it limits the geographic footprint of available services.​
The Health Department recognized this challenge and made a strategic decision: effective March 31, 2025, it transitioned from directly providing MAT services to facilitating partnerships with community providers. This shift aligns with evidence-based approaches emphasizing collaboration, sustainability, and community-centered solutions. In partnership with the Local Behavioral Health Authority, the Health Department is actively supporting the establishment of new medication-assisted treatment clinics in central or southern Prince George’s County to ensure uninterrupted access to care.​
However, a regulatory barrier remained: zoning restrictions limited where these clinics could legally operate. This is where the County Council’s modernization of the zoning ordinance becomes crucial.
Modernizing Zoning to Expand Treatment Access
In November 2025, Prince George’s County Council unanimously enacted Council Bill 027-2025 (CB-027-2025), modernizing the zoning ordinance to remove barriers to opioid treatment expansion. The ordinance accomplishes several key objectives:​
Redefining treatment as a mainstream healthcare use: Rather than treating methadone and buprenorphine clinics as stigmatized, specialized facilities requiring special permits, the ordinance defines state-licensed medical clinics as a new principal use type. This change integrates treatment within the broader framework of medical and healthcare uses, removing the separate and restrictive classification that previously limited siting options.​
Expanding permitted locations: The ordinance establishes the specific zones where treatment clinics are now permitted, dramatically expanding the geographic footprint where treatment can legally operate. This expansion directly addresses one of the most significant barriers to treatment access identified in the research literature.​
Removing methadone treatment centers as a separate restricted use: By eliminating “methadone treatment center” as a distinct principal use type, the ordinance removed an administrative and regulatory layer that complicated facility development and perpetuated stigma. Treatment is now classified within the framework of state-licensed medical clinics, normalizing it as a standard healthcare service.​
Calibrating parking requirements: The ordinance established off-street parking requirements specifically calibrated for treatment centers, set at levels consistent with medical office standards rather than arbitrary or inflated requirements that might make development economically unfeasible.​
Why This Matters for Community Health
The implications of this zoning modernization extend beyond bureaucratic reclassification. For residents seeking treatment, expanded opioid treatment access means several tangible benefits:
Reduced travel barriers: Treatment requires ongoing commitment—patients typically attend clinics multiple times weekly, especially in early recovery. When treatment facilities are concentrated in limited areas, geographic distance becomes a significant barrier. Individuals without reliable transportation, childcare, or flexible work schedules may be unable to access distant clinics, even when they want treatment. Expanded siting options reduce these travel barriers.
Destigmatization: By integrating treatment within mainstream healthcare zoning categories, the ordinance signals that substance use disorder is a treatable medical condition deserving the same regulatory framework as other healthcare services. This destigmatization has downstream effects on community acceptance, provider engagement, and patient willingness to seek treatment.
Increased provider investment: Treatment providers are more likely to invest in communities where zoning permits their operations. Overly restrictive zoning creates uncertainty and prevents development. Modernized zoning removes this uncertainty, encouraging providers to expand service capacity in Prince George’s County.
Equitable access: For Prince George’s County, where Black residents have borne a disproportionate burden of the opioid crisis, expanded treatment access offers the possibility of more equitable health outcomes. However, access alone is insufficient; research shows that Black individuals are less likely to be referred to MAT programs and have lower retention rates, even when treatment is available. Expanded access must be coupled with intentional efforts to eliminate referral disparities and ensure culturally competent, trauma-informed care that addresses the historical mistrust many Black communities hold toward healthcare institutions.​
The Broader Context: Maryland’s Progress and Remaining Challenges
It is important to note that Prince George’s County’s action occurs within a broader context of Maryland’s opioid response. Maryland saw a historic 38 percent decrease in opioid overdose deaths in 2024 compared to 2023, with approximately 1,550 fatal overdoses recorded in 2024—the lowest number since 2015. This dramatic decrease reflects investments in behavioral health, substance use care, and harm reduction programs statewide.​
However, this progress masks persistent challenges. While Maryland has increased medication-assisted treatment capacity significantly—with 103 opioid treatment program (OTP) organizations as of the most recent count, reflecting a 43 percent increase since 2015—critical gaps remain. Many jurisdictions still have treatment capacity exceeding demand while others face significant shortages. Moreover, the shift toward buprenorphine treatment (office-based opioid treatment or OBOT) has increased access in some areas while potentially creating new disparities in others.​
Prince George’s County’s zoning modernization addresses the structural barriers that have historically constrained treatment facility development. By removing regulatory obstacles, the county creates the conditions necessary for providers to expand services and for residents to access care more easily.
A Public Health Imperative
The opioid crisis in Prince George’s County reflects a convergence of factors: the proliferation of fentanyl and other synthetic opioids, socioeconomic stressors, limited mental health resources, and healthcare system fragmentation. No single policy change solves this complex problem. However, removing unnecessary regulatory barriers to treatment represents a concrete step toward addressing one identifiable source of inequitable access.
For the residents of Prince George’s County—particularly those in Black communities hit hardest by overdoses—the modernized zoning ordinance offers expanded opportunities to access medication-assisted treatment services that can prevent overdose death and support long-term recovery. The next phase involves ensuring that expanded treatment infrastructure reaches those who need it most, that cultural and linguistic competency guide service delivery, and that comprehensive support services address the social determinants that underlie substance use disorder.
