Given the dramatic increase in opioid-related overdoses and substance use disorders (SUD), the need for greater access to treatment is significant. Medications in conjunction with the psychosocial and recovery support services (medication-assisted treatment (MAT)) and other SUD treatment services often remain underutilized in behavioral health settings. In addition, barriers to treatment include lack of qualified treatment providers, disparities in treatment program access, regulatory barriers, financial barriers, and negative perceptions associated with treatment. 

This study examines factors that may influence access to MAT and to SUD treatment services more broadly, including negative perceptions associated with SUD treatment, cultural norms, and Medicaid and other insurance coverage. The study also examines state-specific initiatives to combat the opioid epidemic and SUDs.

This study utilized both primary and secondary data and consisted of three parts to address the research questions:

  • Literature review of factors that influence access to MAT and to SUD treatment services more broadly, and efforts being implemented to mitigate these issues. This literature review is critical for building the state survey and themes to investigate via the state-level case studies.
  • A 50-state survey to examine factors that influence access to MAT and SUD treatment services more broadly, as well as state-specific initiatives to combat the opioid epidemic and SUDs in order to compare and contrast regional and state-level patterns.
  • Up to nine state-level case studies.


According to State Opioid Treatment Authorities (SOTAs) and Single State Authorities (SSAs) surveyed and interviewed in each state, states engage in several prevention efforts to address the opioid epidemic and fund a variety of treatment. Among these treatment efforts, the most common recovery support service included peer services and recovery housing. The most common harm reduction efforts are distribution of naloxone (Narcan) in communities impacted by the opioid crisis and community education activities or materials.

Barriers to the treatment of OUD and SUDs range from a lack of qualified treatment providers to financial barriers and negative perceptions associated with treatment. In order to improve access to SUD treatment, including MAT, the following policy and practice changes are recommended:

  1. Strengthening the behavioral health workforce by identifying systems-level factors that influence behavioral health workforce capacity
  2. Broadening patient access to SUD treatment by engaging in cross-agency collaborations, establishing partnerships with local hospitals, and increasing funding, training, and assistance to support initiatives that engage unique populations
  3. Increasing and enhancing financing and reimbursement for treatment
  4. Minimizing stigmatizing attitudes or behaviors that have the potential to lead to a deficiency in patient access to care.


Factors that Influence Access to Medication-Assisted Treatment

Policy Brief
Full Report


Dana Foney, PhD
Shannon Mace, JD, MPH