OUD treatment,7 polysubstance use remains associated with stigma, opioid agonist treatment underdosing,19 and exclusion from treatment.1,20 A 2020 analysis of US veterans reported lower likelihood of buprenorphine receipt associated with cooccurring SUDs.3 A 2021 analysis of US insurance claims found that opioid agonist therapy was underprescribed to individuals with OUD and alcohol use disorder.13 The level of abstinence historically required for patients to remain in buprenorphine treatment has been identified as a factor associated with low buprenorphine initiation and retention in treatment,20 potentially explaining low utilization rates among individuals with cooccurring SUDs.
