["Health Services Research, Volume 61, Issue 3, June 2026. ", "\nABSTRACT\n\nObjective\nTo assess changes in methadone dosing practices among Opioid Treatment Program (OTP) and evaluate adherence to evidence‐based guidelines recommending doses of at least 80 mg/day.\n\n\nStudy Setting and Design\nThis observational study used a national survey of OTPs to examine longitudinal changes in methadone dosing patterns between 2017 and 2023. Key outcomes included patterns in average dose levels and the relationships between program characteristics and dosing practices.\n\n\nData Sources and Analytic Sample\nSecondary data were analyzed from national OTP surveys conducted in 2017 and 2023. The sample included programs that provided data on dosing practices and program characteristics.\n\n\nPrincipal Findings\nThe proportion of OTPs offering the recommended maintenance dose of at least 80 mg/day remained stagnant, moving from 56% in 2017 to 58% in 2023. Concurrently, private‐for‐profit ownership of programs increased from 36% to 53%. Approximately 42% of patients in 2023 received doses below recommended clinical levels, highlighting a significant misalignment between evidence‐based guidelines and actual practice.\n\n\nConclusions\nNational methadone dosing levels stalled between 2017 and 2023. This pattern leaves a significant gap between evidence‐based guidelines and clinical practice, which may limit the effectiveness of methadone maintenance treatment. Targeted interventions are needed to identify the systematic factors hindering the adoption of evidence‐based care and to maximize treatment success.\n\n"]