Using medication-assisted treatment for substance use disorders: Evidence of barriers and facilitators of implementation

The use of medications to treat substance use disorders (SUDs) has emerged as a potentially central part of the treatment armamentarium. In this paper we present data from several recent US national surveys showing that despite the clinical promise of these medications, there has been limited adoption of pharmacotherapies in the treatment of SUDs. The data reveal variable patterns of use of disulfiram, buprenorphine, tablet naltrexone, acamprosate and injectable naltrexone. After examining the environmental and institutional context for the adoption of pharmacotherapies, the specific organizational facilitators and barriers of medication adoption are considered. The paper concludes with a discussion of the minimal clinical and administrative guidance available to enhance adoption, the lack of client and consumer knowledge of medications that puts a brake on their adoption and availability, and the difficulties that must be surmounted in bringing new medications to market.

Research Highlights
► Adoption of pharmacotherapies in the US SUD treatment system remains low.
► Less than 45% of treatment programs prescribe any single SUD pharmacotherapy.
► Data reveal variable patterns in the use of five SUD medications.
► There is minimal clinical and administrative guidance to enhance adoption.
► A lack of client and consumer knowledge of SUD medications limits adoption.