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Methods: Purposive and snowball sampling techniques were used to recruit providers (N=21) who worked closely with MOUD in San Diego County from September 2019-February 2022. The interviews lasted from 30 to 60 minutes. Situational analysis was used as a methodological approach to explore the data and map out the human and non-human elements in the interviews. Elements from the situational analysis were then mapped onto the constructs of the Exploration, Preparation, Implementation, Sustainment (EPIS) Framework, and interviews went through a second phase of coding.
Results: 21 participants working in the substance use field were interviewed, consisting of directors of MOUD programs, health care practitioners, and behavioral health practitioners, Elements of the EPIS constructs pertaining to the outer and inner contexts were found to be both facilitators and barriers of MOUD implementation. For the outer contexts, elements include the service environment and policies, funding for MOUD, funding for patients’ needs, funding for providers, inter-organizational environment and networks, and patient/client characteristics. The inner context elements consisted of leadership, training, organizational characteristics, and individual characteristics of adopters.
Conclusion: Decreasing policy and regulatory barriers can increase MOUD access. Introducing less stringent guidelines has been associated with more physicians prescribing MOUD. The United States healthcare landscape is not conducive to treating substance use disorders, and the disconnect between treatment and insurance creates barriers to care. Further research on training physicians and creating curriculums for future providers are pertinent for the future of MOUD implementation.