I would really like to better understand why substance use researchers are STILL doing traditional office based MOUD trials with very little atttention to underlying social and environmental root causes. We have so many efficacy and effectiveness studies on Bupe and methadone..

I get the frustration that after all the evidence there are still so many barriers for clinicians to prescribe it, but the answer to me doesn’t seem another OBAT RCT. Rather, a focus more on implementation studies, community led initiatives, and a push for policy change.

While I think we should continue to make these life saving medications much more accessible (x the x waiver), I just don’t think this purely biomedical approach will EVER “shift the curve” on substance use disorders as a whole. Espc because we already see stimulants trending up.

What’s going to happen if we see a nation wide shift from opioids to stimulants, where there are virtually no medication based treatments? We need to take a bio-psycho-social model that thinks WAY more about root causes. And again, it needs to be community not physician led.