What’s New in the MOUD Playbook

The updated Playbook offers several key enhancements:

· A stronger emphasis on low-barrier, person-centered care. The Playbook underscores that using MOUD saves lives and should not be withheld due to continued substance use or resistance to counseling. It highlights the need for stigma reduction, appropriate levels of care, and the increasingly important role of primary care providers in maintaining patients on MOUD after initiation, especially in the era of fentanyl.

· New resources, tools, and frontline perspectives. A new Quick Start Guide, with everything providers need to begin offering MOUD treatment, aiming to reduce treatment initiation barriers. The Playbook now features enhanced telehealth guidance; references to the latest research, resources, and tools; and vignettes from patients and providers with lived experience.

· Content updates to reflect the shifting landscape. Updates include major regulatory changes, such as the removal of the X-waiver requirement for prescribing buprenorphine, updates to 42 CFR Part 2 confidentiality protections, expanded telehealth flexibilities, payer acceptance changes, and naloxone’s availability without a prescription. The Playbook also incorporates the growing role of fentanyl and other synthetic opioids, high overdose rates among adolescents, and the unique challenges faced by unhoused and other vulnerable populations.

The Role of the Environmental Scan

The Environmental Scan was central to guiding these changes. The scan synthesized findings from an exhaustive review of more than 8,500 peer-reviewed and grey literature sources, from 2017 to the present, and nine key informant interviews with clinicians, researchers, and policy experts.

Key Findings Driving the Updates

Several findings from the scan directly shaped the updated Playbook:

· Key policy and regulatory changes aimed at improving MOUD availability, such as elimination of the X-waiver, SUPPORT Act provisions, and expansion of telehealth, though barriers remain.

· Secular changes include the dominance of fentanyl, polysubstance use, and overdose disparities.

· Low-barrier care models emerged as best practice, emphasizing same-day initiation of buprenorphine, continued treatment without arbitrary limits, and flexibility to meet patients where they are.

· Persistent stigma, among both communities and providers, remains a barrier, underscoring the need for stigma-reduction strategies and person-first language.

Explore the MOUD in Primary Care Environmental Scan

Why This Matters

For primary care providers and their teams, the updated MOUD Playbook provides a timely, streamlined, and evidence-based guide to delivering effective treatment in a rapidly changing environment. By addressing real-world barriers—from reimbursement to stigma—while promoting low-barrier, person-centered care, the Playbook equips providers with practical tools to save lives and strengthen recovery pathways.

Explore the updated MOUD Playbook

What’s Next

The MOUD Playbook will undergo continuous content updates on a quarterly basis to ensure its content remains current, maximizing its value to providers. We are actively seeking practices who may be interested in participating in a field evaluation for the Playbook that will launch in Spring 2026. Participating practices will receive honoraria for their use of the Playbook and help us shape the Playbook’s usability and impact in real-world settings. Interested practices should reach out to mattreasor@westat.com.

Photo by Jose Aragones on Unsplash