Challenges to and Solutions for Implementing Medications for Opioid Use Disorder in Community Mental Health Centers

Objective

The purpose of this study was to identify implementation challenges to and solutions for integrating medications for opioid use disorder (MOUD) into community mental health centers (CMHCs).

Methods

Between February and July 2024, 17 semistructured interviews were conducted with CMHC program leaders. Participants described the impetus for MOUD provision or reasons for not implementing MOUD, as well as key implementation challenges and strategies to address them.

Results

Participants included staff from 10 CMHCs that provided MOUD and seven that did not. MOUD clinic staff noted that community need and leadership advocacy impelled them to offer MOUD, despite facing challenges. Reasons from non-MOUD clinic staff for not providing MOUD included a perceived lack of opioid use disorder among clients, concerns about treating people with opioid use disorder, and the need for appropriate staff and training. Implementation challenges identified by participants from MOUD clinics concerned the complexity or lack of reimbursement for MOUD-related services, lack of staff training and support, workflow misalignment, client nonadherence to MOUD, and medication costs. Several strategies were described to address these challenges, including streamlining workflows and pathways to treatment, increasing staff training and support, and leveraging telehealth.

Conclusions

Identifying implementation strategies that assist CMHCs in overcoming barriers to integrating MOUD can increase access in settings where people with co-occurring mental and opioid use disorders regularly receive care. This article provides illustrative examples of successful strategies used to address challenges faced by CMHCs and recommendations to increase MOUD uptake.