John had excruciating back pain so his doctor quickly prescribed him opioids.

Over-Prescribing Pharmaceutical companies marketed prescription opioids to physicians who treat chronic pain patients without highlighting the risks of addiction.

Increased access to substances Higher availability of heroin has driven increased use. Nearly 80% of people who use heroin reported using prescription opioids first.

John cannot stop using heroin but doesn't feel like he can tell his family. He is sure he will be punished if he is caught using substances so he does not seek treatment.

Criminalization Fewer than 20% of Americans want a friend, colleague, or neighbor who is addicted to opioids. Over half of those in prison have substance use disorder.

Social isolation Nearly a quarter of emergency, family, and internal medicine providers believe their practice would attract undesirable patients if they treated OUD.

Ashamed, John withdraws from family and friends and decides not to seek help.

Insufficient treatment capacity Isolation and loneliness ripples out to the family and friends of the person with an opioid use disorder. Shame and stigma prevent families from seeking support.

Gaps in evidence-based treatments Local news coverage in states with high opioid overdose rates highlighted more negative consequences of medications for OUD, and fewer than 40 percent of news stories about the medications mentioned they were underused.

Lack of help-seeking Many state Medicaid programs require prior authorization for buprenorphine-naloxone medications. In many states, Medicaid also does not cover residential treatment. Only 60% of employer-sponsored health plans cover Medication for Opioid Use Disorder (MOUD).