Methadone is a life-saving treatment for opioid use disorder, yet in the United States it imposes an exceptional burden on patients due to restrictive and outdated regulations. Unlike other chronic therapies, methadone access is limited to specialized opioid treatment programs (OTPs), requiring frequent in-person visits that create substantial travel, time, and stigma-related barriers. Drawing on findings from Howell et al., this commentary highlights how limited public transportation and geographic concentration of OTPs—particularly in suburban and nonurban areas—restrict access for many patients. While recent policy changes expanding take-home dosing and mobile medication units may reduce travel demands, implementation remains inconsistent. Expanding methadone prescribing to office-based settings with pharmacy dispensing offers the most promising path to improving access, reducing stigma, and aligning treatment delivery with patient needs amid the ongoing overdose crisis.