Organizational Facilitators and Barriers to Medication for Opioid Use Disorder Capacity Expansion and Use
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Journal of Behavioral Health Services & Research, 2020. 1–9. c 2020 National Council for Behavioral Health. DOI 10.1007/s11414-020-09706-4
Organizational Facilitators and Barriers to MOUD
JACOBSON ET AL.
process. The key difference between low- and high-performing organizations was the level of organizational functioning. A better understanding of an organization’s assets and deficits at the individual, organizational, and community levels would allow decision-makers to tailor their approaches to MOUD implementation.
Introduction One hundred and twenty people died per day in the USA in 2018 after overdosing on opioids.1 The total economic burden of prescription opioid misuse is estimated to be $78.5 Billion.2 Increases to child welfare caseloads3 and neonatal abstinence syndrome4 have also occurred through opioid misuse. Coinciding with these trends, the use of medication has emerged as a promising strategy for treating both acute symptoms of opioid use disorder (OUD) and as a maintenance therapy supporting sustained recovery outcomes.5, 6 Medication for opioid use disorder (MOUD) has been shown to increase treatment retention for OUD,7, 8 to reduce opioid use,9, 10 to improve neonatal outcomes for babies born to women with OUDs,11 and to reduce opioid-related mortality rates.12, 13 The American Society of Addiction Medicine, the Substance Abuse and Mental Health Services Administration, and the World Health Organization have relied on the published evidence-based practice to recommend the use of MOUD.14–16 Yet, significant performance gaps exist across the USA. There are entire geographic regions where MOUD is not widely available.17 In addition, many special treatment settings do not offer MOUD18 or underutilize it.19 The three common pharmacotherapies used to treat OUDs are buprenorphine, methadone, and extended-release naltrexone (Vivitrol®). Buprenorphine and methadone are opioid agonists that bind to the opioid receptors in the brain to reduce the effects of opioids. Buprenorphine can only be prescribed by health care providers who have completed training to obtain a waiver allowing them to treat a limited number of patients.20 Patients take the medication daily via tablet or film formulations; a longer-acting implant formulation is also available.21 Methadone can only be dispensed from a location that is licensed to dispense methadone, and these entities tend to be stand-alone, not part of health care clinics. Extended-release naltrexone is typically injected once a month at the prescriber’s office location. Buprenorphine and extended-release naltrexone are more imminently scalable due to fewer regulatory restrictions to offering them in office-based settings. The implementation gap between scientific evidence and clinical practice is well documented, with many examples of underutilized evidence-based practices (EBPs) in general health care22, 23 as well as in substance use disorder specialty care.24, 25 Such an implementation gap exists for MOUD in office-based settings, despite the strong support for the use
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