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 from the National Treatment Center Study, the authors present data from several recent US national surveys (including two waves of onsite data collected from CTPs participating in the National Drug Abuse Treatment Clinical Trials Network (CTN)) 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. This article describes a dysfunctional and perhaps tragic disconnect between science and practice that cannot be closed by the protracted rhetoric about the importance of the adoption of EBPs. Federal agencies and private organizations can invest in pharmacological research, but making those medications available to patients is ultimately a step governed by decisions among investors in the marketplace, the primary issue being ultimate profitability. Given the level of adoption in the data presented here, to say nothing about full-scale implementation, the commercial attractiveness of new SUDs medications is definitely open to question.