Relative effectiveness of integrating MAT in substance abuse specialty programs vs primary care settings; and business models that make integration into primary care more attractive to more providers.

Many primary care docs have their hands full with chronic medical problems and, with few exceptions, do not have the time, interest or resources to get involved with persons having SUDs. Bringing more MAT into primary care will definitely help, but many SUD specialty programs do not use MAT for philosophical reasons (committed to abstinence only rx) or practical (no or very limited medical personnel on staff). These programs are basically operating in a time warp - an era when no effective medications were available.

Standing specialty programs are staffed with persons who are interested in treating patients with SUDs but they are markedly underutilized as places to deliver MAT. Increasing availability of MAT in these settings could increase the impact of this initiative, and bring many of these programs into the 21st century. But, they would need resources to hire nurses and doctors.

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