Lowering the Barriers to Medication Treatment for People with Opioid Use Disorder

Evidence for a Low-Threshold Approach

By Shoshana V. Aronowitz, PhD, MSHP, FNP-BC, Czarina Navos Behrends, PhD, MPH, Margaret Lowenstein, MD, MPhil, MSHP, Bruce R. Schackman, PhD, MBA, and Janet Weiner, PhD, MPH

January 20, 2022

Overdose deaths have reached unprecedented levels in the U.S., despite effective medications to treat opioid use disorders (OUDs). Because the regulatory and administrative barriers to treatment are high, only about 11% of people with OUD receive effective medications, which include buprenorphine, methadone, and naltrexone. In response, clinicians and advocates have looked to a “low-threshold” approach that reduces the stigma surrounding effective medications and facilitates their use.

Written by pilot grant recipient Shoshana Aronowitz, CHERISH Research Affiliate Czarina Behrends, Dissemination & Policy Core Co-director Margaret Lowenstein, CHERISH Director Bruce Schackman, and Janet Weiner, this brief summarizes the barriers to treatment, the evidence on the low-threshold approach, and areas for future research. The evidence suggests that low-threshold approaches can increase access to treatment, with outcomes comparable to high-barrier, standard care. Policymakers, providers, and payers should lower the barriers to medication treatment through regulatory flexibility (including telehealth prescribing), and harm reduction strategies that de-emphasize abstinence and place a priority on initiating or re-initiating treatment whenever and wherever individuals are ready to do so.