Private Equity Investment in Substance Use Disorder Treatment Facilities and Opioid- and Alcohol-Related Mortality

OBJECTIVE: The aim of this study was to describe the association of private equity (PE) investment in substance use disorder treatment facilities in the United States and opioid- and alcohol-related mortality. METHODS: Facilities acquired or founded by PE from 2013 to 2023 were cataloged. Logistic models using cross-sectional data were estimated to predict the presence of at least one PE-owned facility in each U.S. county. RESULTS: Approximately 22.9% of counties had at least one PE-owned treatment facility, and 67.6% of U.S. residents resided in such counties. Counties with (vs. without) PE ownership had nearly twice the opioid mortality rate (21.8 vs. 11.1 per 100,000 population). They were also more likely to be in urban areas (71.4% vs. 26.7%) and had a higher percentage of privately insured individuals (70.0% vs. 67.1%). CONCLUSIONS: PE ownership is less likely to occur in rural areas and more likely to occur in areas with greater opioid treatment need.