Interventions in these high-impact settings to improve screening for OUD and referrals to treatment are among the first steps in stemming the opioid epidemic, the researchers say.

“When it comes to treatment for opioid use disorder, we need to meet people where they are,” said Brandon Marshall, an associate professor of epidemiology at Brown and corresponding author of the study. “We can have the best treatment options out there, but they won’t do any good if we can’t deliver these options in a timely, accessible and non-judgmental way to everyone who might benefit.”

Because frequent visits to a primary care provider or emergency department were closely tied to receiving timely treatment, Macmadu said that’s a great place to start — and Rhode Island is already a national leader in that regard, she noted. Compared to other states, medications for OUD are easy to access, available when needed and covered by insurance. There are no waiting lists for the treatment, and enrollment has been growing steadily for several years, according to data from multiple state health agencies.

“Emergency department-based initiation is an incredible approach to use,” Macmadu said. “These findings have tremendous implications for other states that wish to replicate the increased engagement in treatment we’ve been able to achieve in Rhode Island.”

In addition to screenings and early interventions, Macmadu said that establishing on-demand buprenorphine induction — in which patients receive their first dose of the medication — at key facilities and incorporating peer recovery specialists — individuals who are in recovery themselves and can help to engage and support peers in the early stages of recovery — into overdose response are key to mitigating barriers to treatment.

Not all solutions are health care-based, however. Medicaid recipients tend to be lower-income than the broader population, and enhancing transportation support would have a remarkable impact their ability to receive the care they need.

“If you would like to engage in treatment, but you don’t have transportation, or you have to navigate the logistical issues of childcare, it can be incredibly difficult,” Macmadu said.

Above all, the researchers agree that the simplest, most impactful step toward stemming the tide of overdose is removing the stigma associated with medications for OUD.

Despite years of research that show medications for OUD are the most effective, evidence-based treatment, there is an enduring misconception among patients, physicians and the public that if a person is a patient at a methadone clinic, they’re still addicted to something, and that it’s not “real recovery,” Macmadu explained.

Kimberly Paull, director of data and analytics at EOHHS and one of the co-authors of the paper, said one of the most critical findings of the study was uncovered during focus group conversations with participants — that no improvement is possible if negative beliefs about medications for OUD persist.

“If we have bias, fear and discrimination about treating a disease with a medication, we are hurting people,” Paull said. “We are not showing up to save lives.”

In addition to Macmadu, Marshall and Paull, other co-authors on the paper were Rouba Youssef, Sivakumar Batthala, Kevin H. Wilson, Elizabeth A. Samuels and Jesse L. Yedinak. This study was supported by the State Opioid Response grants programs administered by the Substance Abuse and Mental Health Services Administration. This work was also supported by the Center for Biomedical Research Excellence on Opioids and Overdose, which is funded by the National Institute of General Medical Sciences (P20GM125507).