- The use of FDA-approved medications for the treatment of opioid use disorder (OUD) is a critical tool in reducing the impacts of the opioid crisis. Despite the known benefits of these medications, access to these treatments is lacking more than two decades into the opioid crisis. While most policy changes have focused on supply-side interventions, specifically reducing prescription opioids, and policing illicit opioids and its users, these efforts have not substantially reduced the negative impacts of this public health crisis. Expanding the OUD treatment sector has proven to be a “wicked” problem with a lack of consensus on defining the problem and an inability to ‘solve’ this issue. Using a set of known barriers preventing the expansion of medication-based treatment for OUD (Regulatory barriers, lack of availability of treatment, provider stigmas, and insurance barriers) an analysis of potential solutions and interactions of these barriers was done. While solutions do exist to reduce the regulatory and insurance barriers preventing clinical implementation of these treatment options, the stigmas ingrained over the last century of illicit drug users and misconceptions about maintenance treatment for OUD prevent systemic changes from addressing any one barrier alone. Recognizing this issue as a wicked problem may help guide potential strategies moving forward that address the system rather than its individual components. Oregon is used as a case study to understand the impacts of these barriers on the State’s treatment network and overall access to treatment among the Oregonians with OUD.