They’re pretty available, not gonna act like it isn’t a pain in the ass with clinics opening at like 5:30 and closing at noon but generally that also includes some outpatient therapy and a methadone prescription is dirt cheap cause it is off patent if someone is willing to write you a prescription instead of you going to the clinic everyday although that falls under the same prescribing constraints as opioids. Methadone treatment at a clinic is covered under Medicaid in most states which is our public insurance for people who are shit poor although some states expanded medicaid when we enacted the Affordable Care Act (not mine of course).
It isn’t free but its pretty cheap and most recovering addicts are probably on Medicaid if eligible so like it isn’t a total hardship to the individual but given how low the income thresholds are for Medicaid in some states (like $3,000 a year in some places) whatever copays exist may prevent some people from getting treatment even if they have insurance. Some of the newer opioid blockers that might still be on patent are super expensive. Lack of insurance is definitely a barrier with some counties having double digit % of uninsured with some of those same counties being hit super hard by heroin at the moment. Methadone itself is affordable even without insurance, going to a clinic every day to get your methadone dose ain’t and that seems to be the route that is taken due to adherence and relapse concerns.
On the plus side nalaxone is free now literally almost everywhere, I think we’re a few years away from even talking about replacement therapies being free but given the rate at which people are dropping and the fact that they are mostly white people now there will probably be some movement although they are white trash generally so neither Republicans who they vote for or Democrats who kind of loathe them are super eager to look out for their interests. As heroin has moved into suburbia that has started to change perceptions, politicians and communities are more concerned if it is an honors student from a well to do family that ODs compared to someone from the trailer park. I think the epidemic is going to more or less run its course and then we’ll try and fix it in hindsight but it is systemic problems that even free treatment wouldn’t totally fix.