Advancing Opioid Use Disorder Treatment: A Narrative Review of Evidence-Based Solutions to Systems-Level Barriers in the US

BACKGROUND: Evidence-based practices to treat opioid use disorder (OUD) include behavioral interventions and medications to treat OUD (MOUD). Each type of treatment has unique systems-level challenges that limit care access and care engagement. It is important to identify and address these challenges and provide evidence-based strategies to reduce barriers. METHODS: In this narrative review, systems-level barriers that impede OUD treatment service delivery are reviewed by treatment type (MOUD, cognitive behavioral therapy, and contingency management), and how recent regulatory changes have the ability to reduce or alter these barriers are discussed. To do so, we review empirical literature and regulatory documents to cover the breadth of this topic. RESULTS: Several OUD treatments that have established effectiveness are not able to reach full potential (ie, dissemination, uptake) because of systems-level barriers, notably related to rigid regulations, broad perceptions of treatment, and training and financing constraints. Recent changes aim to lessen restrictions surrounding MOUD delivery (eg, greater allowance for take-home doses of methadone) and allow for delivery of MOUD in innovative settings (eg, mobile health units). There are also reduced restrictions at the treatment provider level, including removal of the X-waiver. Despite lowering some barriers, OUD treatment delivery is still barred by strong forces related dominantly to stigma and financing. CONCLUSIONS: Future research directions to further understand and enhance effective OUD treatment delivery are identified, including the need to address individual, organizational, and external factors that surround the implementation of regulatory changes.