What drives people away from medication for opioid use disorder?

The opioid epidemic is in its fourth and possibly deadliest wave, exacerbated by the COVID-19 pandemic and disproportionately killing people of color. Medications for opioid use disorder (MOUD)—including methadone, buprenorphine, and naltrexone—are effective in combatting the epidemic, but sorely underused. Philadelphia’s Department of Behavioral Health and Intellectual disability Services recently enacted a suite of policies to remove logistical, structural, and payment barriers to MOUD in the publicly-funded behavioral health system, but some facilities still do not use these medications.

Fingers holding a small glass vial of methadone.

To better understand MOUD barriers, Penn Leonard Davis Institute of Health Economics experts interviewed 25 executive directors of publicly funded treatment organizations in Philadelphia that adopted or did not adopt MOUD, finding that stigma towards medications and ideological beliefs about MOUD treatment contribute to non-adoption.

Consistent with national surveys, all participants cited logistical barriers to treatment, including low reimbursement rates and a lack of financial resources that impede hiring necessary medical personnel to prescribe MOUD.

Participants also described organizational discomfort and inertia, noting that incorporating MOUD into treatment was “daunting” and “nightmarish” to manage from an administrative point of view. Both adopter and non-adopter organizations also mentioned a lack of interest and demand from individuals with OUD, stating that the access issue isn’t that places aren’t willing to accept MOUD, it’s that people aren’t interested.

This story is by Rebecca Stewart. Read more at Penn LDI.