It's not just the money: The role of treatment ideology in publicly funded substance use disorder treatment

Medications for opioid use disorder (MOUD) are a first-line treatment for opioid use disorder, yet national surveys indicate that most substance use treatment facilities do not offer MOUD. This article presents the results of a qualitative analysis of interviews with leaders from 25 treatment organizations in Philadelphia, Pennsylvania, that investigated attitudes and barriers toward MOUD. Most treatment organizations that we interviewed are adopting at least one MOUD, suggesting that Philadelphia exceeds the national average of organizations with MOUD capacity. Leaders indicated that both practical resources and ideological barriers thwart adoption and implementation of MOUD in publicly funded substance use disorder treatment agencies. Organizations that had recently adopted MOUDs revealed facilitators to MOUD adoption, such as strong leadership that champions the implementation to staff and redefining recovery from substance use disorders throughout the organization. This study's findings highlight that clients, clinicians, and leadership need to address both practical and ideological barriers to expanding MOUD use.