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Background: Integrating advanced machine-learning (ML) algorithms into clinical practice is challenging and requires interdisciplinary collaboration to develop transparent, interpretable, and ethically sound clinical decision support (CDS) tools. We aimed to design a ML-driven CDS tool to predict opioid overdose risk and gather feedback for its integration into the University of Florida Health (UFHealth) electronic health record (EHR) system. Methods: We used user-centered design methods to integrate the ML algorithm into the EHR system. The backend and UI design sub-teams collaborated closely, both informed by user feedback sessions. We conducted seven user feedback sessions with five UF Health primary care physicians (PCPs) to explore aspects of CDS tools, including workflow, risk display, and risk mitigation strategies. After customizing the tool based on PCPs' feedback, we held two rounds of one-on-one usability testing sessions with 8 additional PCPs to gather feedback on prototype alerts. These sessions informed iterative UI design and backend processes, including alert frequency and reappearance circumstances. Results: The backend process development identified needs and requirements from our team, information technology, UFHealth, and PCPs. Thirteen PCPs (male = 62%, White = 85%) participated across 7 user feedback sessions and 8 usability testing sessions. During the user feedback sessions, PCPs (n = 5) identified flaws such as the term "high risk" of overdose potentially leading to unintended consequences (e.g., immediate addiction services referrals), offered suggestions, and expressed trust in the tool. In the first usability testing session, PCPs (n = 4) emphasized the need for natural risk presentation (e.g., 1 in 200) and suggested displaying the alert multiple times yearly for at-risk patients. Another 4 PCPs in the second usability testing session valued the UFHealth-specific alert for managing new or unfamiliar patients, expressed concerns about PCPs' workload when prescribing to high-risk patients, and recommended incorporating the details page into training sessions to enhance usability. Conclusions: The final backend process for our CDS alert aligns with PCP needs and UFHealth standards. Integrating feedback from PCPs in the early development phase of our ML-driven CDS tool helped identify barriers and facilitators in the CDS integration process. This collaborative approach yielded a refined prototype aimed at minimizing unintended consequences and enhancing usability. [ABSTRACT FROM AUTHOR]

Objectives: Buprenorphine, a medication for opioid use disorder (OUD), is underutilized in general medical settings. Further, it is inequitably received by racialized groups and persons with comorbidities. The Veterans Health Administration launched an initiative to increase buprenorphine receipt in primary care. The project's objective was to identify patient-related factors associated with buprenorphine receipt and retention in primary care clinics (n = 18) participating in the initiative. Methods: Retrospective cohort quality improvement evaluation of patients 18 years or older with 2 or more primary care visits in a 1-year period and an OUD diagnosis in the year before the first primary care visit (index date). Buprenorphine receipt was the proportion of patients with OUD who received 1 or more buprenorphine prescriptions from primary care providers during the post–index year and retention the proportion who received buprenorphine for 180 days or longer. Results: Of 2880 patients with OUD seen in primary care, 11.7% (95% confidence interval [CI], 10.6%–12.9%) received buprenorphine in primary care, 58.2% (95% CI, 52.8%–63.3%) of whom were retained on buprenorphine for 180 days or longer. Patients with alcohol use disorder (adjusted odds ratio [AOR], 0.39; 95% CI, 0.27–0.57), nonopioid drug use disorder (AOR, 0.64; 95% CI, 0.45–0.93), and serious mental illness (AOR, 0.60; 95% CI, 0.37–0.97) had lower buprenorphine receipt. Those with an anxiety disorder had higher buprenorphine receipt (AOR, 1.42; 95% CI, 1.04–1.95). Buprenorphine receipt (AOR, 0.55; 95% CI, 0.35–0.87) and 180-day retention (AOR, 0.40; 95% CI, 0.19–0.84) were less likely among non-Hispanic Black patients. Conclusions: Further integration of addiction services in primary care may be needed to enhance buprenorphine receipt for patients with comorbid substance use disorders, and interventions are needed to address disparities in receipt and retention among non-Hispanic Black patients. [ABSTRACT FROM AUTHOR]

Background and aims: Patient navigation (PN) may benefit pregnant individuals with opioid use disorder (OUD) by improving treatment adherence. We examined participant enrollment, session delivery and assessment feasibility for a PN intervention among pregnant participants and compared PN preliminary effectiveness for OUD treatment engagement with participants in usual care (UC). Design: This study was a pilot single‐blinded multi‐site randomized trial. Setting: Two academic medical centers in Pennsylvania (n = 57) and Utah (n = 45), United States participated. Participants: One hundred and two pregnant adult participants unestablished (fewer than 6 weeks) on medication for OUD (MOUD) were randomized to PN (n = 53) or UC (n = 49). Intervention: PN was composed of 10 prenatal sessions (delivered after baseline but before the prenatal assessments) and four postnatal sessions (delivered before the 2‐ and 6‐month postpartum assessments) focused upon OUD treatment and physical/mental health needs. UC involved brief case management. Measurements Feasibility assessments included consent, session delivery and assessment rates. Mixed‐effect models for intent‐to‐treat (ITT) and per protocol (PP, received six or more sessions) populations were estimated to compare outcomes of MOUD use, secondary outcomes of substance use disorder (SUD) treatment attendance and non‐prescribed opioid use, and exploratory outcome of overdose at baseline, predelivery and 2 and 6 months postpartum. Findings We consented 87% (106 of 122) of the proposed target, delivered ~60% of sessions delivered and completed ≥ 75% assessments. PN ITT and PP had better MOUD adherence, SUD treatment attendance, non‐prescribed opioid use and overdose outcomes than UC. Notable changes included good evidence for greater percentage change in days for PN PP MOUD use from baseline to 2 months postpartum [PN = 28.0 versus UC = −10.9, 95% confidence interval (CI) = 9.7, 62.1] and some evidence for baseline to 6 months postpartum (PN = 45.4 versus UC = 23.4, 95% CI = −0.7, 48.2). PN PP percentage change in days for SUD treatment attendance also showed good evidence for improvements from baseline to prenatal assessment (PN = 7.4 versus UC = −21.3, 95% CI = 3.3, 53.5). PN compared to UC participants reported fewer overdoses at 2 months (PN = 11.9%/UC = 16.1%) and at 6 months postpartum (PN = 3.8%/UC = 6.2%). Conclusions: Patient navigation appears to be associated with improvements in opioid use disorder treatment engagement and overdoses during pregnancy. This pilot trial shows the feasibility of the intervention and a future large‐scale trial. [ABSTRACT FROM AUTHOR]

Background: Rural and frontier communities face high rates of opioid use disorders (OUDs). In 2021, the Rural Addiction Implementation Network (RAIN) sought to establish a rural hospital/clinic-system practice-based research network (RH-PBRN) to facilitate implementation of evidence-based addiction-related prevention, treatment, and recovery (PTR) services to reduce the morbidity of OUD and substance use disorder (SUD) in rural communities.Objective: To describe the goals and implementation of PTR activities of RAIN, a novel RH-PBRN.Methods: RAIN identified teams of external/internal facilitators at four rural hospitals/clinic-networks to achieve at least 15 PTR activities involving OUD and other SUDs. RAIN utilized an implementation-facilitation approach: facilitators assessed the implementation environment and promoted interventions to overcome barriers to PTR implementation. Other interventions included site visits, community of learning calls, and e-communication. RAIN assessed and recorded facilitators and barriers to implementation, milestone attainment, and outcomes of PTR activities. At 18 months, we queried facilitators about the fidelity and implementation of RAIN activities.Results: RAIN established an HP-PBRN in four sites (Idaho, Montana, Utah, and Wyoming). Within the HP-PBRN, 20 PTR activities were established (p = 7, T = 10, R = 3; range 3–7 per site). Barriers to implementation of PTR activities included competing clinical demands, especially due to COVID-19, lack of dedicated effort for staff at sites, and stigma of addiction and its treatment. Facilitators of implementation included the use of trained expert facilitators and communication between the sites.Conclusions: RAIN implemented 20 addiction-related PTR activities in four rural hospitals/clinic-networks. RAIN’s intervention model could be replicated to address addiction-related harms in other rural communities. [ABSTRACT FROM AUTHOR]

Objective Data Sources and Study Setting Study Design Data Collection Methods Principal Findings Conclusions To identify organizational service features associated with positive patient ratings of primary care within primary care clinics tailored to accommodate persons with ongoing and recent experiences of homelessness (PEH).PEH receiving primary care in 29 United States Veterans Health Administration homeless‐tailored clinics were surveyed about their primary care experience using the validated Primary Care Quality‐Homeless (PCQ‐H) survey. Characteristics of the clinics were assessed through surveys of clinic staff using a new organizational survey developed through literature review, site visits, statistical analysis, and consensus deliberation.Cross‐sectional examination of patients' ratings of care based on surveys of patients, and of clinic characteristics, analyzed with Classification and Regression Tree (CART) analysis, a form of machine learning.Patient surveys (n = 3394) were obtained from a random sample of enrolled patients by both mail and telephone by an external survey contractor. Staff (n = 52 from 29 clinics) were interviewed by telephone.This analysis identified service features that impact patient experience favorably, including aspects of patient‐centeredness, team identity, strong external leadership support, and service that reach beyond traditional primary care clinic confines. Results varied according to the patient experience scale analyzed. Individual characteristics of PEH, such as degree of social support, general health, and unsheltered status, were also correlated with how they rate care.Organizational characteristics correlate with ratings of primary care from patients with recent and ongoing homelessness. Primary care programs serving homeless individuals can assure better care based on who they hire, how they foster team identity, what services they provide, and the strength of leadership support to protect a homeless‐focused mission. [ABSTRACT FROM AUTHOR]

Objectives: Hospitals are increasingly offering treatment for substance use disorders (SUDs) during medical admissions. However, there is a lack of consensus on the best approach to facilitating a successful transition to long-term medical and SUD care after hospitalization. We aimed to establish a hierarchy of existing SUD care transition models in 2 categories-effectiveness and implementation-using an expert consensus approach., Methods: We conducted a modified online Delphi study that convened 25 interdisciplinary clinicians with experience facilitating posthospitalization care transitions for patients with SUD. Panelists rated 10 prespecified posthospitalization care transition models according to 6 criteria concerning each model's anticipated effectiveness (eg, linkage to care, treatment retention) and implementation (eg, feasibility, acceptability). Ratings were made on a 9-point bidirectional scale. Group consensus was determined using the interpercentile range adjusted for symmetry., Results: After 3 rounds of the Delphi process (96% retention across all 3 rounds), consensus was reached on all 60 rating criteria. Interdisciplinary addiction consult teams (ACTs) and in-reach from partnering outpatient clinics were rated highest for effectiveness. Interdisciplinary ACTs and bridge clinics were rated highest for implementation. Screening, brief intervention, and referral to treatment; protocol implementation; and postdischarge outreach received the lowest ratings overall. Feasibility of implementation was perceived as the largest challenge for all highly rated models., Conclusions: An expert consensus approach including diverse clinician stakeholders found that interdisciplinary ACT, in-reach from partnering outpatient clinics, and bridge clinics had the greatest potential to enhance posthospitalization care transitions for patients with SUD when considering both perceived effectiveness and implementation., Competing Interests: S.G.’s spouse is a salaried employee of Eli Lilly and Company and owns stock. S.K. owns stock in 2 health related companies, Thermo Fisher Scientific and Dexcom, and receives royalties from a publisher, Wolters-Kluwer. No other authors report relevant conflicts of interest., (Copyright © 2024 American Society of Addiction Medicine.)

Background: All federal agencies are required to support appropriation requests with evidence and evaluation (US Public Law 115-435; the Evidence Act). The StrAtegic PoLicy EvIdence-Based Evaluation CeNTer (SALIENT) is 1 of 6 centers that help the Department of Veterans Affairs (VA) meet this requirement., Objective: Working with the existing VA evaluation structure, SALIENT evaluations will contribute to (1) optimize policies and programs for veteran populations; (2) improve outcomes regarding health, equity, cost, and provider well-being; (3) advance the science of dissemination and knowledge translation; and (4) expand the implementation and dissemination science workforce., Methods: We leverage the Lean Sprint methodology (iterative, incremental, rule-governed approach to clearly defined, and time-boxed work) and 3 cores to develop our evaluation plans collaboratively with operational partners and key stakeholders including veterans, policy experts, and clinicians. The Operations Core will work with evaluation teams to develop timelines, facilitate work, monitor progress, and guide quality improvement within SALIENT. The Methods Core will work with evaluation teams to identify the most appropriate qualitative, quantitative, and mixed methods approaches to address each evaluation, ensure that the analyses are conducted appropriately, and troubleshoot when problems with data acquisition and analysis arise. The Knowledge Translation (KT) Core will target key partners and decision makers using a needs-based market segmentation approach to ensure that needs are incorporated in the dissemination of knowledge. The KT Core will create communications briefs, playbooks, and other materials targeted at these market segments to facilitate implementation of evidence-based practices and maximize the impact of evaluation results., Results: The SALIENT team has developed a center infrastructure to support high-priority evaluations, often to be responsive to shifting operational needs and priorities. Our team has engaged in our core missions and operations to rapidly evaluate a high-priority areas, develop a comprehensive Lean Sprint systems redesign approach to training, and accelerate rapid knowledge translation., Conclusions: With an array of interdisciplinary expertise, operational partnerships, and integrated resources, SALIENT has an established and evolving infrastructure to rapidly develop and implement high-impact evaluations. Projects are developed with sustained efficiency approaches that can pivot to new priorities as needed and effectively translate knowledge for key stakeholders and policy makers, while creating a learning health system infrastructure to foster the next generation of evaluation and implementation scientists., International Registered Report Identifier (irrid): PRR1-10.2196/59830., (©Mary Jo Pugh, Jolie N Haun, P Jon White, Gerald Cochran, April F Mohanty, Lisa M McAndrew, Adam J Gordon, Richard E Nelson, Megan E Vanneman, Diana E Naranjo, Rachel C Benzinger, Audrey L Jones, Jacob Kean, Susan L Zickmund, Angela Fagerlin. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 19.09.2024.)

Background: While most pregnant individuals with methamphetamine use disorder (MUD) achieve abstinence, the postpartum period remains a vulnerable time for return to methamphetamine use (MU). Promising data from human and animal models, including three randomized controlled trials, suggest that micronized progesterone may prevent postpartum return to cocaine and nicotine use by reducing cravings. The primary objective of this study is to assess feasibility of enrollment and randomization of postpartum individuals with MUD to micronized progesterone to prevent return to MU. The secondary objectives are to evaluate safety, establish a preliminary estimate of efficacy, and characterize the association between allopregnanolone levels and methamphetamine cravings., Methods: This is a pilot double-blind placebo randomized controlled trial. We plan to enroll 40 postpartum individuals with MUD over 24-months. Individuals, stratified by opioid use disorder (OUD), are randomized 1:1-400 mg oral micronized progesterone daily or placebo and attend weekly study sessions for 12 weeks. Feasibility is measured by achieving 80 % of enrollment goal. Safety is evaluated by side effect frequency, mental health status changes, lactation and medical complications. Efficacy is assessed by comparing proportion of participants with return to MU and time to return to MU based on self-report or urine testing between treatment and control groups. Salivary allopregnanolone levels and methamphetamine cravings are compared between the groups., Conclusion: Study results will provide a first critical step towards potential intervention for prevention of return to MU among postpartum individuals. Completion of this trial will set the stage for a large-scale efficacy trial., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Unrelated to this work, the University of Utah receives funds to support Marcela. C. Smid from Gilead Science Inc for a study on hepatitis C treatment in pregnancy and Jada device from Alydia/Organon Inc. She serves as a consultant for Organon and Rhia Ventures. The University receives funds to support Jasmin E Charles from Gilead Science Inc for a study on hepatitis C treatment in pregnancy. She also serves as a consultant for Gilead Science Inc., (© 2024 The Authors.)

Objectives: Trauma screening is recommended for pregnant persons with opioid use disorder (OUD), but there is limited literature on screening results from buprenorphine treatment. This study's objectives were to 1) describe the types, and severity, of traumatic events reported and 2) evaluate the associations between trauma and health-related quality of life (HRQoL)., Methods: Baseline data from an ongoing trial were analyzed. Participants were 155 pregnant persons with OUD receiving, or enrolling in, buprenorphine treatment at one of 13 sites. The experience, and relative severity, of 14 high magnitude stressors were assessed with the trauma history screen. The Patient-Reported Outcomes Measurement Information System-29+2 was used to assess 8 HRQoL domains., Results: Traumatic stressors were reported by 91% of the sample (n = 155), with 54.8% reporting a lifetime persisting posttraumatic distress (PPD) event and 29.7% reporting a childhood PPD event. The most prevalent lifetime PPD event was sudden death of a close family/friend (25.8%); physical abuse was the most prevalent childhood PPD event (10.3%). Participants with lifetime PPD, relative to no PPD, reported significantly greater pain interference (P = 0.02). Participants with childhood PPD, relative to no PPD, had significantly worse HRQoL overall (P = 0.01), and worse pain intensity (P = 0.002), anxiety (P = 0.003), depression (P = 0.007), fatigue (P = 0.002), and pain interference (P < 0.001)., Conclusions: A majority of pregnant persons enrolled/enrolling in buprenorphine treatment reported persisting posttraumatic distress with sudden death of close family/friend being the most prevalent originating event; clinicians should consider the impact that the opioid-overdose epidemic may be having in increasing trauma exposure in patients with OUD., Competing Interests: Conflicts of interest: AD reports royalties for academic books from OUP, Springer, PESI Publishing and from Oakstone CME. AJD reports receiving an honorarium for an online chapter on alcohol management in the perioperative period from the UpToDate online reference and serving pro bono on 3 non-for-profit Board of Directors of national/international organizations, with none of the efforts being related to the contents of this manuscript. EEK reports being an investigator on grants to Magee-Womens Research Institute from the National Institutes of Health, Gilead, and Merck outside of the submitted work. MRL reports being a research consultant for Berkshire Biomedical, Braeburn, Journey Colab, and Titan Pharmaceuticals in the last 3 years. The other authors declare no conflicts of interest., (Copyright © 2024 American Society of Addiction Medicine.)

Introduction: Many individuals receiving outpatient physical therapy have musculoskeletal pain and up to one-third use prescription opioids. The impact of physical therapist-led mindfulness-based interventions integrated with evidence-based physical therapy (I-EPT) to manage patients with chronic musculoskeletal pain and long-term opioid treatment has not been elucidated. This project evaluates the feasibility of conducting a cluster randomised trial to test the effectiveness of I-EPT., Methods and Analysis: Study 1 aim: Refine and manualise the I-EPT treatment protocol. Our approach will use semistructured interviews of patients and physical therapists to refine an I-EPT training manual. Study 2 aim: Evaluate different intensities of physical therapist training programmes for the refined I-EPT treatment protocol. Physical therapists will be randomised 1:1:1 to high-intensity training (HighIT), low-IT (LowIT) training and no training arms. Following training, competency in the provision of I-EPT (LowIT and HighIT groups) will be assessed using standardised patient simulations. Study 3 aim: Evaluate the feasibility of the I-EPT intervention across domains of the Reach, Effectiveness, Adoption, Implementation, Maintenance implementation framework. The refined I-EPT treatment protocol will be tested in two different health systems with 90 patients managed by the randomised physical therapists. The coprimary endpoints for study 3 are the proportions of the Pain, Enjoyment of Life and General Activity Scale and the Timeline Followback for opioid use/dose collected at 12 weeks., Ethics and Dissemination: Ethics approval for the study was obtained from the University of Utah, University of Florida and Florida State University Institutional Review Boards. Informed consent is required for participant enrolment in all phases of this project. On completion, study data will be made available in compliance with NIH data sharing policies., Trial Registration Number: NCT05875207., Competing Interests: Competing interests: AJG receives an honorarium for an online chapter on alcohol management in the perioperative period from the UpToDate online reference (https://www.uptodate.com/home). This effort is not related to the contents of this manuscript.In the last three years, AJG has been on the board of directors for the American Society of Addiction Medicine (ASAM; https://www.asam.org), the Association for Multidisciplinary Education and Research in Substance use and Addiction (AMERSA; https://amersa.org) and the International Society of Addiction Journal Editors (ISAJE; https://www.isaje.net), all non-for profit organisations. AJG does not receive remuneration for these duties and all organisations are non-for profit. AJG also deem these relationships not related to the contents of this manuscript.EG is the Director of the Centre on Mindfulness and Integrative Health Intervention Development. The Centre provides Mindfulness-Oriented Recovery Enhancement (MORE), mindfulness-based therapy, and cognitive behavioural therapy in the context of research trials for no cost to research participants; however, EG has received honoraria and payment for delivering seminars, lectures and teaching engagements (related to training clinicians in MORE), including those sponsored by institutions of higher education, government agencies, academic teaching hospitals and medical centres. EG also receives royalties from the sale of books related to MORE. EG is also a licensor to BehaVR., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Traditional methadone treatment (MT) for opioid use disorder (OUD) fails to systematically address the physical pain, emotion dysregulation, and reward processing deficits that co-occur with OUD, and novel interventions that address these issues are needed to improve MT outcomes. Mindfulness-Oriented Recovery Enhancement (MORE) remediates the hedonic dysregulation in brain reward systems that is associated with OUD. Our pilot and phase 2 randomized controlled trials of MORE were the first to demonstrate MORE's feasibility, acceptability, and efficacy as delivered in MT clinics; MORE significantly reduced drug use (eg, benzodiazepines, barbiturates, cocaine, marijuana, opioids, and other drugs), craving, depression, anxiety, and pain among people with OUD. However, uptake of novel, efficacious interventions like MORE may be slow in MT because time and resources are often limited. Therefore, to best address potential implementation issues and to optimize future MORE implementation and dissemination, in this study, we will utilize a Type 2, Hybrid Implementation-Effectiveness study design. We will not only evaluate MORE's effectiveness but also assess barriers and facilitators to integrating MORE into MT. MT clinicians will receive training in (1) a higher intensity MORE implementation strategy consisting of training in the full MORE treatment manual or (2) a minimal intensity implementation strategy consisting of a simple, scripted mindfulness practice (SMP) extracted from the MORE treatment manual with minimal training. We aim to: (1) using a Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, examine barriers and facilitators to implementation of MORE and SMP in MT, and evaluate strategies for optimizing training, fidelity, and engagement, (2) optimize existing MORE and SMP training and implementation toolkits, including adaptable resources that can accelerate the translation of evidence into practice, and (3) compared to usual MT, evaluate the relative effectiveness of MORE plus MT or SMP plus MT (N = 450)., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Eric Garland, PhD, LCSW is the Director of the Center on Mindfulness and Integrative Health Intervention Development. The Center provides Mindfulness-Oriented Recovery Enhancement (MORE), mindfulness-based therapy, and cognitive behavioral therapy in the context of research trials for no cost to research participants; however, Dr Garland has received honoraria and payment for delivering seminars, lectures, and teaching engagements (related to training clinicians in mindfulness) sponsored by institutions of higher education, government agencies, academic teaching hospitals, and medical centers. Dr Garland also receives royalties from the sale of books related to MORE. Dr Garland is a licensor to BehaVR, LLC. No other authors have conflicts to disclose.

Objectives: The aim of this study was to examine expert views on the effectiveness and implementability of state policies to improve engagement and retention in treatment for opioid use disorder (OUD)., Methods: We conducted a 3-round modified Delphi process using the online ExpertLens platform. Participants included 66 experts on OUD treatment policies. Experts commented on 14 hypothetical state policies targeting treatment engagement and quality of care. Using the GRADE Evidence-to-Decision framework, we conducted reflexive thematic analysis to develop patterns of meaning from the dataset., Results: Only policies for providing continued access to evidence-based treatment for highly at-risk populations, settings, and periods were seen as effective in meaningfully reducing population-level opioid-related overdose mortality. Experts commented that, although the general public increasingly supports policies expanding medications for OUD and evidence-based care, ongoing stigma about OUD encourages public acceptance of punitive and paternalistic policies. Experts viewed all policies as at least moderately feasible given the current infrastructure and resources, with affordability reliant on long-term cost savings from reduced opioid-related harms. Equitability depended on whether experts perceived a policy as inherently equitable in its design as well as concerns about the potential for inequitable implementation due to structural oppression and interpersonal biases in criminal-legal, healthcare, and other systems., Conclusions: Experts believe that supportive (rather than punitive) policies improve engagement and retention in OUD treatment. States could prioritize implementing supportive policies that are patient-centered and take a harm-reduction approach to enhance medications for OUD access and utilization. States could consider deimplementing punitive policies that are coercive, take an abstinence-only approach, and use punitive and restrictive measures., (Copyright © 2023 American Society of Addiction Medicine.)