The prospects for sustaining evidence-based responses to the US opioid epidemic: state leadership perspectives

Abstract

Background The US 21st Century Cures Act provided $7.5 billion in grant funding to states and territories for evidence-based responses to the opioid epidemic. Currently, little is known about optimal strategies for sustaining these programs beyond this start-up funding. Methods Using an inductive, conventional content analysis, we conducted key informant interviews with former and current state leaders (n = 16) about barriers/facilitators to sustainment and strategies for sustaining time-limited grants. Results Financing and reimbursement, service integration, and workforce capacity were the most cited barriers to sustainment. Status in state government structure, public support, and spending flexibility were noted as key facilitators. Effective levers to increase chances for sustainment included strong partnerships with other state agencies, workforce and credentialing changes, and marshalling advocacy through public awareness campaigns. Conclusions Understanding the strategies that leaders have successfully used to sustain programs in the past can inform how to continue future time-limited, grant-funded initiatives.

Promoting sustainable responses to the US opioid epidemic with community-academic partnerships: qualitative outcomes from a statewide program

“…Although the SOR grants fund much-needed community level interventions, many of the services they support may not be sustainable [ 9 ]. One challenge faced by local grantees is that sustainable substance use prevention and treatment services rely on networks of collaborators, including payor sources for services.…”

“…Although complex, these collaborative networks permit SOR-funded entities to overcome inter- and intra-organizational barriers, including limited fiscal resources and expertise, to sustain grant-funded programs [ 10 ]. Overcoming these barriers requires that grantees identify, leverage, and report on external factors, including partners and processes that will support new services throughout the service implementation pathway [ 9 – 12 ]. In addition to health service providers, these partners can include religious institutions, civic organizations, and law enforcement agencies who do not share a common or comprehensive understanding of the evidence base related to SUD treatment.…”

Sustainability planning in the US response to the opioid crisis: An examination using expert and text mining approaches

“…From an implementation practice perspective, state addiction prevention and treatment system authorities need and want guidance on how to leverage change in policy, financing and regulations so that the best available programs are, and remain, accessible to their citizens across the entire system. Practical information for systems leaders about effective and efficient sustainment strategies is therefore sorely needed [ 61 ].…”

Promoting Sustainable Responses to the US Opioid Epidemic with Community-Academic Partnerships: Qualitative Outcomes from a Statewide Program.

“…Although complex, these collaborative networks permit SOR-funded entities to overcome interand intra-organizational barriers, including limited scal resources and expertise, to sustain grant-funded programs. 10 Overcoming these barriers requires that grantees identify, leverage, and report on external factors, including partners and processes that will support new services throughout the service implementation pathway. 9,10,11,12 In addition to health service providers, these partners can include religious institutions, civic organizations, and law enforcement agencies who do not share a common or comprehensive understanding of the evidence base related to SUD treatment.…”

“…10 Overcoming these barriers requires that grantees identify, leverage, and report on external factors, including partners and processes that will support new services throughout the service implementation pathway. 9,10,11,12 In addition to health service providers, these partners can include religious institutions, civic organizations, and law enforcement agencies who do not share a common or comprehensive understanding of the evidence base related to SUD treatment. There is a need for research to support the sustainable implementation of SOR-funded services.…”