Most Community Behavioral Health Clinics Still Skip Long-Acting Injectable Opioid Treatment, Study Finds

Long-acting injectable medications have been hailed as one of the most promising tools in the fight against opioid use disorder, offering patients weeks of protection from withdrawal and cravings with a single shot. Yet a new study published in BMC Health Services Research reveals that the clinics best positioned to deliver these treatments are largely failing to do so. Researchers at the University of Connecticut School of Medicine analyzed data from hundreds of certified community behavioral health clinics across the United States and found that fewer than one in four clinics offering any medications for opioid use disorder had adopted the injectable buprenorphine formulation, a gap that could shape how the nation tackles its ongoing overdose crisis.

The findings arrive at a moment when federal and state policymakers are paying renewed attention to certified community behavioral health clinics, a care model created through the Excellence in Mental Health and Substance Use Disorder Treatment Act and expanded through recent demonstration programs. These clinics are required to serve anyone who walks through their doors regardless of ability to pay, insurance status, or severity of illness, and they must provide a defined set of services spanning mental health and substance use care, crisis response, and coordination with physical health providers. Because of this mandate, they often serve populations with the greatest barriers to care, including people experiencing homelessness, individuals involved with the criminal justice system, and residents of rural or underserved communities. That positioning makes the low uptake of long-acting injectable buprenorphine documented in the study more consequential than it might appear at first glance, since the patients most likely to benefit from a treatment that removes the daily burden of taking medication are often the same patients these clinics serve.

Long-acting injectable formulations of buprenorphine work by releasing the medication slowly over weeks or, in some products, months, maintaining steady blood levels that suppress withdrawal symptoms and reduce cravings without the peaks and valleys associated with daily oral dosing. For patients, this can mean fewer decisions to make each day about whether to take medication, less stigma associated with daily clinic visits for observed dosing, and a reduced risk of diversion or accidental misuse. Clinicians have also noted that the injection schedule creates natural touchpoints for regular contact with the treatment team, which can reinforce engagement with counseling and other services. Clinical guidelines from major professional bodies list these formulations as a first-line option alongside oral buprenorphine and methadone, yet adoption across the treatment system has lagged well behind the evidence base, a pattern the study’s authors describe as an implementation problem rather than a question of clinical merit.

The survey data underlying the analysis come from the National Substance Use and Mental Health Services Survey, an annual census-style effort administered by the federal government that collects detailed information from behavioral health facilities across the country. By restricting their sample to the 419 certified community behavioral health clinics that reported providing at least one medication for opioid use disorder, the researchers isolated a group of facilities that had already crossed the initial threshold of offering pharmacotherapy, allowing them to examine what distinguishes clinics that went further and added the injectable formulation. The statistical approach combined chi-square tests to identify bivariate associations with logistic regression to estimate the independent contribution of each organizational characteristic, producing a model that explained roughly a third of the variation in adoption, a substantial share for research of this kind and a signal that the measured factors capture meaningful differences between clinics.

Regional patterns stood out prominently in the results. Clinics in the Northeast were markedly more likely to offer the injectable formulation than those in other parts of the country, a finding consistent with broader geographic disparities in access to medications for opioid use disorder that have been documented in prior research. Northeastern states have generally had higher rates of buprenorphine prescribing across all settings, which some observers attribute to earlier policy adoption, denser treatment infrastructure, and greater prescriber availability per capita. The regional concentration suggests that implementation efforts may need to be tailored differently depending on local context, since strategies that succeed in areas with established prescribing networks may not transfer easily to regions where the workforce and supply chains for these medications remain thin.

Quality improvement activity emerged as another strong correlate. Clinics that engaged in intensive quality improvement practices, such as clinical provider peer review and root cause analysis, were significantly more likely to have adopted the injectable formulation. This association aligns with a well-established body of implementation science showing that organizations with structured processes for examining their own performance tend to adopt evidence-based practices more readily. Peer review gives clinicians a mechanism to discuss prescribing decisions with colleagues and surface barriers they might not otherwise articulate, while root cause analysis helps teams trace problems such as low uptake back to specific, addressable causes rather than attributing them to vague notions of patient resistance. The authors frame these findings through the Consolidated Framework for Implementation Research, a widely used model that organizes the determinants of implementation success into domains spanning characteristics of the intervention, the inner setting of the organization, the outer setting of policy and payer environment, the individuals involved, and the processes by which change is accomplished.

Perhaps the most actionable finding concerns prescriber availability. Clinics that reported having prescribers available within the clinic or its network were substantially more likely to offer the injectable medication, and this variable alone accounted for a notable share of the explained variation in the exploratory analysis. The connection is intuitive once the practical requirements of the treatment are considered. Injectable buprenorphine must be administered by a healthcare professional, typically requiring a valid prescription, appropriate storage of the product, trained staff to give the injection, and scheduling systems that accommodate periodic visits. A clinic without reliable prescriber access faces obstacles at every one of these steps. Workforce shortages in addiction medicine and psychiatry are well documented, particularly in rural areas, and the finding suggests that expanding prescriber capacity, whether through recruitment, telehealth arrangements, or collaborative practice agreements, may be among the most direct levers for increasing availability of the treatment.

The authors are careful to note limitations that shape how the findings should be interpreted. The cross-sectional design captures a single point in time and cannot establish whether quality improvement activity or prescriber availability caused clinics to adopt the formulation, or whether clinics already inclined toward innovation simply do both. The survey relies on self-report from facilities, which introduces the possibility of reporting error or social desirability bias. The analysis also examined clinics that already offered some form of medication for opioid use disorder, so it says little about the larger population of behavioral health facilities that offer no pharmacotherapy at all, a group that remains substantial in national surveys. The authors describe their examination of prescriber availability as exploratory, indicating that it should be tested in future research with more rigorous designs before being treated as settled.

Even with those caveats, the study offers a useful map for implementation efforts. Rather than treating low adoption as a monolithic failure, it identifies specific organizational characteristics that distinguish adopters from non-adopters within a single, well-defined clinic model. For administrators of certified community behavioral health clinics, the findings suggest concrete questions to ask about their own operations: whether prescribers are available to initiate and maintain patients on injectable formulations, whether quality improvement structures exist that could surface and address barriers, and whether regional factors such as payer policies or state-level support for medication access are helping or hindering. For policymakers, the results underscore that the national footprint of these clinics represents an underused platform for expanding evidence-based addiction treatment, and that targeted support for prescriber capacity and organizational improvement processes could accelerate adoption in the settings where the need is greatest.

The timing of the research also matters. As the demonstration program for certified community behavioral health clinics moves toward broader implementation and as federal initiatives continue to emphasize evidence-based treatment for opioid use disorder, the pressure on these clinics to offer the full range of approved medications will likely intensify. Long-acting injectable buprenorphine occupies a particular niche in that landscape, sitting between daily oral medication and opioid treatment programs that dispense methadone, and offering an option for patients who struggle with adherence to daily regimens but do not require the regulatory structure of methadone. Understanding which clinics have managed to incorporate it, and why, provides a starting point for closing a gap that currently leaves most medication-providing clinics without this option, and by extension leaves many patients without access to a form of treatment that could meaningfully change the course of their recovery.

Subject of Research: Adoption of long-acting injectable buprenorphine in certified community behavioral health clinics

Article Title: Characteristics of certified community behavioral health clinics that offer long-acting injectable medications for opioid use disorders

Article References: Hutchison, M., Fuss, C., & O’Grady, M. A. (2026). Characteristics of certified community behavioral health clinics that offer long-acting injectable medications for opioid use disorders. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15633-5

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15633-5

Keywords: opioid use disorder, long-acting injectables, behavioral health clinics, buprenorphine, health services research, Characteristics, certified, community, behavioral, health, clinics, offer