Abstract
We appreciate the opportunity to respond to Cartus and Marshall’s (1) commentary on our paper (2). First, we would like to thank them for their kind feedback and their excellent discussion of numerous structural factors that impact the opioid epidemic and, in particular, the suboptimal and inequitable treatment of opioid use disorder (OUD). We wholeheartedly agree that upstream changes at the national, state, local, and clinical levels (like the recent repeal of the X-waiver requirement for buprenorphine prescribing) are sorely needed to improve access to and quality of medication for opioid use disorder (MOUD) treatments to all who could benefit. Cartus and Marshall raise an interesting set of issues regarding the potential trade-offs between investing in technical sophistication and public health considerations. We are sympathetic to the concern that the broader social context, policy environment, and general public health relevance may sometimes be considered secondary to the technical goals of a particular analysis. However, we do not see technical sophistication and public health relevance as a zero-sum game. In fact, we believe that technical sophistication can, in certain cases, even help clarify public health relevance.
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