Insight
MOUD Access Is a Logistical Problem, Not a Clinical One
I didn't start my career planning to build technology for opioid treatment programs. I was a clinical pharmacist in a Montana hospital, caring for newborns and families in the neonatal intensive care unit (NICU).
Opio didn't start with a product idea. It started with patients I couldn't stop thinking about, and with Dr. Robert Sherrick, an addiction medicine physician at Community Medical Services, who fundamentally changed how I understood addiction. He explained how addiction rewires the brain and how treatment allows people to regain stability and their lives. He also helped me see something bigger: the opioid crisis doesn't stay contained to the person using drugs. It touches families, schools, healthcare systems, and entire communities.
When someone who needs treatment is able to access it, the benefit doesn't stop there. It ripples outward to their family and community. And once you see that clearly, especially in healthcare, you can't unsee it.
What I Saw, I Couldn't Ignore
In 2016, I began working in the NICU. At times, nearly half of the babies in our care were experiencing neonatal abstinence syndrome (NAS). Until then, I didn't fully understand how deeply the opioid crisis had reached into Montana's rural communities.
Two things stood out immediately. First, addiction didn't look like I thought it would. Many of these parents looked like anyone else. I had to confront my own bias as a healthcare professional. Stigma is real, even in medicine. Second, it was painfully obvious that where someone lived directly affected whether they would succeed in treatment and whether their baby would go home with them or enter foster care.
Many of the mothers lived on nearby reservations or in rural towns hours from the nearest opioid treatment program (OTP). For many, buprenorphine wasn't clinically effective. Methadone, a full opioid agonist and one of the most evidence-based treatments for opioid use disorder, was the best option.
But Montana has only four OTPs, the only facilities authorized to provide methadone for opioid use disorder. When starting treatment, patients often need frequent visits while doses are adjusted. That means frequent travel.
I met a mother driving from Minot, North Dakota to Billings, Montana, a 280-mile round trip, while pregnant, because methadone was the only medication that worked for her. No one should have to travel that far for lifesaving care.
But across America, drive time determines whether treatment is realistic. When access fails, the outcomes follow a familiar pattern: missed treatment opportunities, babies entering foster care, families separated, higher mortality, higher healthcare costs, and higher criminal justice costs. The cycle doesn't break without treatment.
These outcomes are often described as unavoidable consequences of addiction. What I saw told a different story. Mothers connected to an OTP kept their babies. Mothers who couldn't access treatment often lost custody. Same disease. Completely different outcomes.
The difference wasn't motivation, it was distance. This wasn't a failure of medicine, it was a failure of access.
MOUD Works. Access Is the Barrier.
Medications for opioid use disorder (MOUD), including methadone and buprenorphine, are the gold standard of care. The evidence is clear.
The challenge was never whether treatment worked. The challenge was whether patients could realistically reach it, sustain it, and build a life around it.
In hospital settings, patients were often identified and referred appropriately. But many systems lacked operational pathways to initiate treatment in real time or ensure continuity afterward. The clinical intention was there. The logistics were not.
At the same time, I was using pharmacy automation and remote dose verification every day in the hospital. Automation wasn't experimental. It was normal healthcare infrastructure. Rural hospitals relied on technology to deliver safe, consistent medication management despite staffing shortages.
Then I walked into an OTP for the first time. It felt like stepping back in time. Almost everything was manual. I expected it to look and feel like healthcare, the same safety systems, the same operational support. It didn't.
I kept thinking: if we could use technology to support rural hospitals, why weren't we building systems that helped opioid treatment programs reach patients in other communities? That question changed the direction of my career.
The Real Bottleneck Isn't Clinical. It's Operational.
I spent years studying how opioid treatment programs operate within federal and state regulatory frameworks, including 42 CFR Part 8. What became clear was this:
The greatest barrier to expanding methadone access isn't clinical uncertainty. It's operational design inside a highly regulated system.
OTPs must manage:
- Daily observed dosing
- Medication preparation
- Verification and documentation
- Inventory reconciliation
- Narrow dosing windows
- Workforce shortages
All of it must be precise. All of it must be compliant. All of it must be safe. And when clinics try to expand into rural or underserved communities, they face additional realities: high labor costs, brick-and-mortar expenses, difficulty recruiting qualified staff, and real financial risk if census doesn't scale quickly enough.
It's not that providers don't want to expand. It's that the current infrastructure makes it incredibly hard, both from a financial and logistical perspective.
Why We Founded Opio
In 2021, I partnered with engineer Mike Dawson to found Opio. Our goal was to help OTPs serve rural and underserved communities in a way that is compliant, operationally sound, and financially sustainable. We knew that if we had to change regulations we wouldn't succeed in making the impact we hoped for, so we set out to build something that fit into the operational and regulatory constraints of the current system, and to support the hardworking healthcare professionals in the OTP field.
Our first product, ZING®, automates methadone dose preparation inside DEA-registered opioid treatment programs. By reducing manual workload and standardizing preparation, clinics improve consistency, reduce staff burnout, and free nurses and pharmacists to focus on patient care.
That shift isn't just about efficiency. It's about safety, capacity, and sustainability.
Now, we've developed ZING Satellite™. This isn't an add-on. It's the reason we started. It's about allowing OTPs to extend care into rural communities while maintaining centralized clinical oversight and compliance.
MOUD saves lives. It reduces societal costs. Zip code shouldn't dictate treatment options.
The infrastructure to deliver MOUD equitably in every community doesn't fully exist yet. But it will. Opio was built to close that gap.
Amber Norbeck, PharmD
Co-Founder & Chief Product and Innovation Officer, Opio Connect
