"They should be like penicillin": barriers to the integration of medications for opioid use disorder in specialty treatment programs.

BACKGROUND: Specialty drug treatment programs should be a key setting to treat opioid use disorder (OUD), but most programs continue to not treat OUD patients with evidence-based medications for opioid use disorder (MOUD). COVID-19 introduced some flexibilities that could improve uptake of MOUD but ongoing barriers have not been examined. We examined barriers and facilitators to integrating MOUD post-COVID among specialty treatment programs in New Jersey. METHODS: Between March-July 2023, we conducted 14 semi-structured qualitative interviews with leadership and clinical staff of New Jersey specialty outpatient drug treatment programs, with varying levels of client MOUD uptake. Thematic analysis examined barriers and facilitators to providing MOUD in specialty treatment programs in the post-COVID-19 era. RESULTS: Treatment providers revealed that financial barriers, including gaps in insurance coverage after COVID Medicaid expansions were terminated, continue to prevent MOUD use. Second, despite new buprenorphine telehealth flexibilities, a shortage of buprenorphine providers continues to limit ability to offer MOUD. Third, stigma against MOUD among clients, families, providers, and ancillary service providers such as housing programs continues to prevent MOUD initiation. Successful facilitators include expanding educational efforts on effectiveness of MOUD and harm reduction for clients and community members, forming specialized partnerships with pharmacies, and expanding care coordination efforts for those on MOUD. CONCLUSIONS: Despite efforts by federal and state governments, MOUD continues to be underutilized in specialty treatment settings, introducing significant risks for patients. Efforts should focus on reducing gaps in insurance coverage, improving provider knowledge of regulatory changes around MOUD, and supporting anti-stigma campaigns.