Objective. To describe round-trip drive times and travel distance to methadone clinics among Medicaid enrollees in West Virginia, testing for differences between those in rural versus urban areas. Findings. In this cross-sectional analysis of West Virginia Medicaid enrollees' claims from 2018–2019, methadone recipients on average traveled almost an hour round-trip to receive their daily treatment. The travel burden was substantially higher among those in more rural areas. Meaning. These findings indicate that it may be difficult for patients to adhere to their methadone treatment regimen, perhaps leading to suboptimal treatment rates and outcomes.