Laws for expanding access to medications for opioid use disorder: a legal analysis of 16 states & Washington D.C

ABSTRACT

Background: Medications for opioid use disorder (MOUDs) are the gold standard for OUD treatment but are underused. To our knowledge, no published study has systematically identified and categorized state policy innovations for expanding MOUD utilization.

Objective: We sought to identify and categorize state MOUD policy innovations.

Methods: Within a stratified random sample of 16 U.S. states and Washington D.C. we searched for 2019 state statutes and regulations related to MOUD in Westlaw legal database. We then identified laws that appeared designed to increase MOUD utilization and categorized them using a template analysis approach.

Results: We found 82 laws with one or more MOUD expansion policies. We identified six high-level MOUD expansion policy categories: 1) policies expanding the availability of waivered buprenorphine providers; 2) needs assessments and policies increasing public MOUD awareness; 3) criminal justice system policies; 4) Substance use disorder (SUD) treatment and sober living facility policies; 5) insurance policies; and 6) hospital policies. SUD treatment and housing facility policies, as well as insurance policies, were most common.

Conclusions: Multipronged approaches are being pursued by several states to increase MOUD access. Our results can inform policymakers of MOUD expansion approaches in other jurisdictions. Policy categories can serve as the basis for policy variables for future analyses of policy effects.

KEYWORDS:

• methadone
• buprenorphine
• state
• policy
• law
• opioid use disorder
• medications for opioid use disorder
• qualitative
• insurance
• criminal justice

Authors’contributions

Dr. Andraka-Christou conceptualized the project, conducted primary data analysis, oversaw data analysis, and drafted the manuscript. Ms. Totaram, Ms. Randall-Kosich, and Mr.Golan participated in data collection and assisted with analysis. Dr. Stein provided research funding, supervised the project, and edited the manuscript. Dr. Gordon and Dr. Saloner assisted with data interpretation and edited the manuscript.

Consent for publication

All authors provide their consent for publication. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or any of its academic affiliates.

Data availability statement

No applicable. All state laws are in the public domain.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

NIH National Institute on Drug Abuse, Awards # [R01DA045800 and P50DA046351]; with principal investigator Dr. Bradley Stein from the RAND Corporation. Brendan Saloner acknowledges funding support from Arnold Ventures. Adam Gordon acknowledges support from [NIH UG1DA04944].