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An assessment of policy and practice-based solutions to increase access to medication treatment for opioid use disorder
Dissertation

An assessment of policy and practice-based solutions to increase access to medication treatment for opioid use disorder

Kimberly D. Williams
Doctor of Public Health (Dr.P.H.), Drexel University
Mar 2026
DOI:
https://doi.org/10.17918/00011319
pdf
Williams_Kimberly_20262.06 MB
PDF Embargoed Access, Embargo ends: 30 Apr 2028

Abstract

Social research Analgesic opioids Health services accessibility Implementation science Opioid-related disorders Primary health care Prior authorization
Factors contributing to the ongoing drug overdose crisis in the United States represent a complex interplay of multi-level influences across the socio-ecological spectrum. Multiple efforts at the policy, organizational system, and individual health care provider levels have attempted to address and, as a result, played an important role in better understanding the contributing factors and barriers to accessing treatment for opioid use disorder (OUD). However, the impact of these multi-level efforts has demonstrated limited and underwhelming results. In addition, OUD treatment access rates have languished and remain persistently low. This indicates that no single solution can effectively improve access to care for people with OUD. Integrating OUD treatment in primary care through office-based opioid treatment (OBOT) models presents a promising solution to increase treatment access and offer patients holistic and longitudinal care addressing their biopsychosocial needs. Despite the presence of effective medications for OUD (MOUD), the knowledge of essential elements necessary to deliver evidence-based OBOT programs, and knowledge of the multi-faceted barriers that can impede success, it remains unknown which strategies can improve uptake and sustain this evidence-based intervention in clinical practice. The goal of this dissertation research was to assess multi-level factors -- including key policy, organizational, and individual barriers -- to deliver MOUD and identify policy and practice solutions to increase access to OBOT in primary care. Theoretical principles of the socio-ecological model guided this research by framing the multi-level barriers to MOUD and the interplay of these barriers between levels of influence. State Medicaid policies were explored in Chapter 2 (Aim 1) to examine regulatory barriers related to prior authorization requirements for buprenorphine prescribing. Chapter 3 (Aim 2) explored contextual factors related to delivering OBOT services in primary care clinics by examining provider and staff experiences including barriers and facilitators at the individual, interpersonal, organizational and community, and policy and financial levels. Chapter 4 (Aim 3) synthesized prior organizational-level efforts to improve MOUD access in primary care using OBOT models and offered recommendations utilizing implementation research approaches to close the gap between evidence-based research knowledge and real-world clinical practice.

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