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Dynamics of prescribing and accessing medications for opioid use disorder: a community-based systems analysis.

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Title: Dynamics of prescribing and accessing medications for opioid use disorder: a community-based systems analysis.
Authors: Herman, Tianna, Hasgul, Zeynep, Lim, Tse Yang, Jalali, Mohammad S., Stringfellow, Erin J.
Source: Addiction Research & Theory. Jun2025, Vol. 33 Issue 3, p231-242. 12p.
Subjects: Substance abuse, Health services accessibility, Community health services, Patient compliance, Fear, Qualitative research, Causal models, Research funding, Interviewing, Termination of treatment, Culture, System analysis, Simulation methods in education, Thematic analysis, Physician practice patterns, Drug prescribing, Drugs, Opioid epidemic, Buprenorphine, Social stigma
Abstract: Background: Although medications for opioid use disorder (MOUD) are effective for treating opioid use disorder (OUD), persistent barriers still prevent patients from accessing this life-saving care. Policies to increase MOUD access have produced suboptimal results. This study presents a qualitative system dynamics model that elucidates the complexities of accessing and staying in MOUD treatment. Methods: We utilized a community-based system dynamics approach to modeling the MOUD treatment system. We engaged a cohort of system experts/stakeholders, including individuals who had received MOUD, treatment providers, and policymakers, in interviews and group model building to develop and refine a simulation model. We then created a qualitative causal loop diagram based on insights gained while developing the simulation model and a review of interview transcripts. Results: The causal loop diagram captures four key factors affecting treatment initiation, retention, and leaving: (1) fraught interactions between patients and healthcare providers; (2) stigma-driven regulation of MOUD creating a culture of fear and defensive medicine; (3) a punitive culture in clinics and opioid treatment programs offering MOUD; and (4) the internalization of the abstinence narrative contributing to premature termination of treatment. Conclusions: Our analysis highlights how interdependent and non-linear feedback processes diminish or counteract the effectiveness and sustainability of MOUD policy interventions. Due to system memory and cultural resistance to change, even rolling back reactionary policies may do little to curb established behavioral patterns. In addition, conflicting and competing strategies among various actors within the system contribute to goal misalignment and a lack of standardization of care. [ABSTRACT FROM AUTHOR]
Copyright of Addiction Research & Theory is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Dynamics of prescribing and accessing medications for opioid use disorder: a community-based systems analysis.
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  Data: <searchLink fieldCode="AR" term="%22Herman%2C+Tianna%22">Herman, Tianna</searchLink><br /><searchLink fieldCode="AR" term="%22Hasgul%2C+Zeynep%22">Hasgul, Zeynep</searchLink><br /><searchLink fieldCode="AR" term="%22Lim%2C+Tse+Yang%22">Lim, Tse Yang</searchLink><br /><searchLink fieldCode="AR" term="%22Jalali%2C+Mohammad+S%2E%22">Jalali, Mohammad S.</searchLink><br /><searchLink fieldCode="AR" term="%22Stringfellow%2C+Erin+J%2E%22">Stringfellow, Erin J.</searchLink>
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  Data: <searchLink fieldCode="JN" term="%22Addiction+Research+%26+Theory%22">Addiction Research & Theory</searchLink>. Jun2025, Vol. 33 Issue 3, p231-242. 12p.
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  Data: <searchLink fieldCode="DE" term="%22Substance+abuse%22">Substance abuse</searchLink><br /><searchLink fieldCode="DE" term="%22Health+services+accessibility%22">Health services accessibility</searchLink><br /><searchLink fieldCode="DE" term="%22Community+health+services%22">Community health services</searchLink><br /><searchLink fieldCode="DE" term="%22Patient+compliance%22">Patient compliance</searchLink><br /><searchLink fieldCode="DE" term="%22Fear%22">Fear</searchLink><br /><searchLink fieldCode="DE" term="%22Qualitative+research%22">Qualitative research</searchLink><br /><searchLink fieldCode="DE" term="%22Causal+models%22">Causal models</searchLink><br /><searchLink fieldCode="DE" term="%22Research+funding%22">Research funding</searchLink><br /><searchLink fieldCode="DE" term="%22Interviewing%22">Interviewing</searchLink><br /><searchLink fieldCode="DE" term="%22Termination+of+treatment%22">Termination of treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Culture%22">Culture</searchLink><br /><searchLink fieldCode="DE" term="%22System+analysis%22">System analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Simulation+methods+in+education%22">Simulation methods in education</searchLink><br /><searchLink fieldCode="DE" term="%22Thematic+analysis%22">Thematic analysis</searchLink><br /><searchLink fieldCode="DE" term="%22Physician+practice+patterns%22">Physician practice patterns</searchLink><br /><searchLink fieldCode="DE" term="%22Drug+prescribing%22">Drug prescribing</searchLink><br /><searchLink fieldCode="DE" term="%22Drugs%22">Drugs</searchLink><br /><searchLink fieldCode="DE" term="%22Opioid+epidemic%22">Opioid epidemic</searchLink><br /><searchLink fieldCode="DE" term="%22Buprenorphine%22">Buprenorphine</searchLink><br /><searchLink fieldCode="DE" term="%22Social+stigma%22">Social stigma</searchLink>
– Name: Abstract
  Label: Abstract
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  Data: Background: Although medications for opioid use disorder (MOUD) are effective for treating opioid use disorder (OUD), persistent barriers still prevent patients from accessing this life-saving care. Policies to increase MOUD access have produced suboptimal results. This study presents a qualitative system dynamics model that elucidates the complexities of accessing and staying in MOUD treatment. Methods: We utilized a community-based system dynamics approach to modeling the MOUD treatment system. We engaged a cohort of system experts/stakeholders, including individuals who had received MOUD, treatment providers, and policymakers, in interviews and group model building to develop and refine a simulation model. We then created a qualitative causal loop diagram based on insights gained while developing the simulation model and a review of interview transcripts. Results: The causal loop diagram captures four key factors affecting treatment initiation, retention, and leaving: (1) fraught interactions between patients and healthcare providers; (2) stigma-driven regulation of MOUD creating a culture of fear and defensive medicine; (3) a punitive culture in clinics and opioid treatment programs offering MOUD; and (4) the internalization of the abstinence narrative contributing to premature termination of treatment. Conclusions: Our analysis highlights how interdependent and non-linear feedback processes diminish or counteract the effectiveness and sustainability of MOUD policy interventions. Due to system memory and cultural resistance to change, even rolling back reactionary policies may do little to curb established behavioral patterns. In addition, conflicting and competing strategies among various actors within the system contribute to goal misalignment and a lack of standardization of care. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of Addiction Research & Theory is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – Type: doi
        Value: 10.1080/16066359.2024.2420087
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      – Code: eng
        Text: English
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        PageCount: 12
        StartPage: 231
    Subjects:
      – SubjectFull: Substance abuse
        Type: general
      – SubjectFull: Health services accessibility
        Type: general
      – SubjectFull: Community health services
        Type: general
      – SubjectFull: Patient compliance
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      – SubjectFull: Fear
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              Text: Jun2025
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