The Opioid Crisis: Scaling Up Treatment And Harm Reduction Programs To Reach More People Who Would Benefit.

A central challenge in the opioid crisis in the US has been the underuse of lifesaving treatment and harm reduction programs. Conventional explanations focus on limited access to care when services are not convenient, affordable, or timely. However, these factors exist downstream from other fundamental causes of low utilization. In this article, we focus on the upstream challenges of scaling effective programs to reach more people who would benefit. The opioid crisis spurred numerous inventive approaches such as buprenorphine administered by paramedics and vehicles equipped to dispense methadone. Yet most people with opioid use disorder (OUD) never receive these lifesaving medications. Similarly, harm reduction programs such as syringe services programs and naloxone distribution are vastly underused. Scaling interventions to reduce harm and treat people with OUD will require addressing both technical constraints, such as program complexity, and social barriers, such as opposing community views, to develop effective programs and ensure that they are used by those who need them most.