Three-Quarters of the Clinics Built to Treat Opioid Addiction Still Don't Offer the Shot

Certified community behavioral health clinics were designed to be the places where the hardest-to-reach patients actually get care. They must serve anyone who walks in, regardless of insurance, ability to pay or how sick they are. They are, by construction, the front door for people who have no other door.

A new analysis published in BMC Health Services Research finds that most of that front door leads to the same medication options it did a decade ago. Among 419 clinics that already prescribed something for opioid use disorder, 325 — 77.6 percent — did not offer long-acting injectable buprenorphine, the formulation that holds patients for weeks on a single dose.

The study, by Morica Hutchison, Cailyn Fuss and Megan A. O'Grady at the University of Connecticut School of Medicine, used the 2022 National Substance Use and Mental Health Services Survey. Restricting the sample to clinics already providing medication was deliberate: it isolates the question of why some organizations go further from the larger and bleaker question of why others prescribe nothing at all.

Two Factors Separated Adopters From Everyone Else

Geography was the strongest signal. Clinics in the Northeast were markedly more likely to offer the injectable, a pattern that tracks with earlier findings on buprenorphine prescribing generally — denser treatment infrastructure, earlier policy adoption, more prescribers per capita.

The second was internal. Clinics that ran intensive quality improvement work, including clinical peer review and root cause analysis, were significantly more likely to have adopted the formulation. The combined model explained roughly a third of the variance, a large share for organizational research of this kind.

An exploratory analysis pointed at the most practical barrier of all. Clinics with prescribers available inside the clinic or its network were substantially more likely to offer the injectable, and that variable alone accounted for about 15 percent of the variance. The mechanism is not mysterious. An injection must be prescribed, stored, administered by trained staff and scheduled at regular intervals. A clinic without reliable prescriber access fails at the first step and never reaches the others.

What the Study Cannot Say

The design is cross-sectional, so it cannot establish whether quality improvement habits caused adoption or whether clinics already inclined to innovate simply do both. The data are self-reported and four years old. And because the sample was limited to clinics that already offered medication, it says nothing about the larger population of behavioral health facilities that offer no pharmacotherapy at all.

What it does say is specific enough to act on. For a clinic administrator, the questions are concrete: is there a prescriber who can initiate and maintain patients on an injectable, and does the organization have a process that surfaces barriers rather than attributing low uptake to patient reluctance? For policymakers, the finding lands at an awkward moment, as the demonstration program for these clinics moves toward broader implementation while the medication-assisted treatment menu on offer remains narrower than the evidence base.

Long-acting injectable buprenorphine sits in a useful niche, between a daily oral dose that some patients cannot sustain and the daily clinic attendance that methadone treatment requires. Nearly four in five clinics positioned to offer it are not.