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treatments have been shown to reduce overdose risk and mortality.179 However, people of color, pregnant people and individuals with children may find it difficult to access or complete treatment due to the barriers erected by some social determinants of health.180,181,182 Pregnant and postpartum individuals experience additional barriers given the lack of integration between OB/Gyn care and SUD treatment. Some individuals live in treatment deserts without any treatment at all or with treatment too distant to be accessible via available or affordable transportation.183 Finally, while the recent overdose epidemic began as a problem predominately in White people related to the oversupply of prescription opioids, overdose rates have begun climbing in people of color. 184,185 2 These numbers do not include people in institutional settings like prisons, jails, dormitories, or hospitals, and they also do not count individuals who are experiencing homelessness, leading to an undercount of people who may benefit from treatment « « « « « « 46 NATIONAL DRUG CONTROL STRATEGY Neighborhoods with smaller White populations may have less access to certain treatments (e.g., buprenorphine).186 Other underserved areas include rural counties, Tribal communities, and states that thus far have chosen not to expand Medicaid. 3 EBTs can improve outcomes but are not as widely available as they need to be.187 Research has shown that for OUDs, the U.S. Food and Drug Administration (FDA) approved medications most effectively reduce overdose mortality, increase abstinence, and improve quality of life.188 Research with office-based buprenorphine has shown that adding additional behavioral therapy sometimes does not improve outcomes.189,190 For OUDs related to prescription opioids, research reported that medicine managed by a prescriber can produce abstinence outcomes as good as medication plus a very robust psychosocial evidence-based treatment.191 Recognizing the overall effectiveness of FDA approved MOUD, they should be accessible to any individual with an OUD regardless of the availability of, or their willingness to participate in, additional therapy except where that participation is mandated by regulation. People with SUD often face prejudice, stigma, and discrimination, and this especially affects Black individuals.192 Stigmatizing attitudes towards drug use and people who use drugs (PWUD) exist throughout our society, including in health care.193 One study found that PWUD were discouraged from accessing medical care because they do not trust health care providers to maintain their privacy from law enforcement.194 We must continue to ensure privacy protections for people in treatment while removing stigma in health care to enhance patient engagement in treatment.195,196 Systems engineering and behavioral health research suggest that a focus on validation and elements of process improvement science are critical for engagement in treatment.197,198,199 Research shows that people with SUD are viewed more negatively than people with physical or other mental disorders. 200,201 When the subject of a vignette was referred to as a “substance abuser” rather than as a “person having a substance use disorder,” even highly trained SUD and mental health clinicians were significantly more likely to assign blame and believe that an individual should be subjected to punitive (e.g., jail sentence) rather than therapeutic measures.202 Blame is counterproductive because many factors other than individual decisionmaking impact whether a person tries a drug or develops SUD. Adverse Childhood Experiences (ACEs), like growing up in a home with a parent with SUD increases the risk for developing SUD.203 To increase the number of people in treatment, societal attitudes towards people with SUD must change. The U.S Preventive Services Task force recently recommended screening adults for unhealthy substance use as a Grade B recommendation.204 Members of the health, child welfare and justice systems should receive training to recognize SUD as a medical condition like diabetes or cancer. Practitioners and support staff should receive training to serve these individuals. Finally, attitudes more broadly about people in need of treatment can change but this likely only will happen if individuals feel safe to speak up. Treatment is effective and an estimated 23 million people in this country are in recovery.205 However, additional work is necessary to eliminate the unmet need for evidence-based SUD treatment. To meet the Strategy’s stated treatment goals, including increased access to quality treatment, reduced stigma, dedicated interventions for the most vulnerable, and a trained 3 The Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) extended Medicaid eligibility to all adults under age 65 with incomes below 133 percent of the federal poverty level. However, the June 2012 National Federation of Independent Business (NFIB) v. Sebelius Supreme Court decision effectively made the expansion optional for states. « « « « « « NATIONAL DRUG CONTROL STRATEGY 47 workforce are necessary. In addition, novel approaches such as the use of technology206 to facilitate entrance and retention in treatment must also be supported. Federal agencies must support efforts nationwide 

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