Research to law: A qualitative study of Massachusetts' 2018 Care Act expanding emergency department initiation of medication for opioid use disorder

Background: Initiating medication for opioid use disorder (MOUD) during emergency department (ED) visits is an important innovation to engage individuals in addiction treatment. In 2018, Massachusetts passed the CARE Act, becoming the first state to legislate that hospitals with EDs must be able to offer MOUD. We performed a qualitative study to explore factors influencing policy enactment. Methods: Semi-structured interviews were conducted in 2019 with ten key stakeholders involved in the policymaking process representing state government, hospitals, physician professional societies, and recovery/behavioral health organizations. Data were analyzed in 2020–2021 using a hybrid inductive-deductive approach. Results: The first key theme stakeholders expressed was the importance of research and public health consensus; they described consensus building within existing coalitions regarding the pressing need for action, and supporting expansion of treatment with this evidence-based strategy. Second, stakeholders discussed overcoming financing and feasibility concerns by passing budget-neutral legislation and ensuring flexibility for diverse hospital types. Lastly, stakeholders looked towards implementation, describing the implementation guide development process and ensuring capacity for continuing treatment existed throughout the state. Conclusions: This study suggests that research supporting the effectiveness of ED MOUD induction drove the passage of this state legislation. Long-term collaboration between diverse stakeholders towards a common goal of increasing access to evidence-based treatment to address the opioid epidemic was also perceived as facilitating the law's passage. Policymakers and advocates in other states may look towards Massachusetts's legislative process as a model for implementing similar legislation as part of their strategies to address the drug overdose crisis.