Massachusetts Expands Access to Substance Use Treatment

The U.S. substance use crisis has evolved beyond opioids. Alcohol has long been a leading cause of substance-related deaths, and provisional data shows that in 2024, over half of all overdose deaths involved stimulants. In response, some states are adapting their addiction treatment systems to reach more people.

Massachusetts has increased access through its nurse care manager model for office-based addiction treatment. In this model, providers hire a dedicated nursing staff to assess and monitor patients and coordinate their care.

The model launched in 2007 to serve patients with opioid use disorder, and Massachusetts extended eligibility to people with alcohol and stimulant use disorders in 2022. Since then:

• Patient enrollment rose from 3,687 in 2020 to 4,319 in 2024, a 17% increase.
• Non-opioid admissions grew from 639 (17.4% of admissions) in fiscal year 2020 to 1,682 (39% of admissions) in fiscal 2024.
• The number of people admitted who were taking medication for alcohol use disorder increased from 295 (8.8% of admissions) in 2020 to 899 (22.5%) in 2024.

"By providing dedicated staff with substance use expertise in primary care settings, we have empowered health care providers to serve more patients and deliver comprehensive, coordinated care,” said Nicole Schmitt, director of the Office of Health Data, Strategy, and Innovation at Massachusetts’ Bureau of Substance Addiction Services. “Our outreach efforts—such as partnering with community partners and engaging with individuals in the community—are helping us reach people who need treatment most.”

As of spring 2025, more than 40 sites contract with the bureau to care for people with opioid, alcohol, and stimulant use disorders. Personnel at the sites receive technical assistance and training, and providers can also participate in a free 12-session videoconferencing assistance program offered by Boston Medical Center. Jen Miller, director of grants and innovation at the bureau, said this technical assistance is “run and developed by a program that implements [SUD treatment] services, so they’re keenly aware of some of the challenges and successes.”

How more states can address alcohol and stimulant use disorders

States can build on their own approaches to treating opioid use disorders in office-based settings by expanding eligibility for people with other substance use disorders, as Massachusetts has done.

Another key to success is incentivizing clinicians to provide care through adequate reimbursement. Massachusetts funds the nurse care manager model through a mix of Medicaid reimbursement, state general funds, and federal dollars—including the Substance Use Prevention, Treatment, and Recovery Services Block Grant and the State Opioid Response Grant—to pay for services that are not covered by Medicaid.

Clinicians also need additional training and technical assistance as Massachusetts provides through Boston Medical Center using federal grant dollars.

As policymakers throughout the country look to strengthen their response to the overdose crisis, evidence-based, feasible initiatives will be key to their success. Massachusetts’ results demonstrate the potential impact of building on existing systems of care.

Frances McGaffey works on The Pew Charitable Trusts’ substance use prevention and treatment initiative.