Regulations play a significant role in shaping the landscape of substance use disorder (SUD) treatment in the United States, influencing everything from access to care to the delivery of evidence-based practices. Amidst the COVID-19 pandemic, key regulations facilitated access to substance use disorder (SUD) treatment. But with recent regulatory changes, we're facing new challenges. We're highlighting the complexities of navigating federal and state regulations affecting telehealth, medication access, and harm reduction strategies. We're calling for updated policies and greater collaboration among stakeholders to improve outcomes in the SUD treatment community.