Turning Policy Into Practice: Using Implementation Science to Expand Access to Addiction Treatment
For Erika Crable, PhD, MPH, implementation science is personal. Growing up in the D.C. and Baltimore areas, she witnessed how the “three waves” of the U.S. opioid epidemic—the prescription drug crisis of the 1990s, the rise of heroin in the 2000s, and the spread of synthetic opioids in the years since— devastated families and communities, including her own.
“Overdose deaths are preventable,” she said. “We have harm reduction and treatment practices that work, but access often depends on your ability to pay. Our systems just aren’t meeting the demand or delivering quality care.”
While completing her doctorate, Crable worked full time as a policy consultant for the Centers for Medicare & Medicaid Services and SAMHSA. She realized that much of what she was doing—helping government agencies translate evidence into practice—was implementation science, even if it didn’t have that name yet. “We didn’t need new interventions,” she said. “We needed to get the ones that work into the hands of people who need them.”
A Natural Fit at C-DIAS
Crable joined the Center for Dissemination and Implementation at Stanford (C-DIAS) through her long-standing mentorship with Dr. Mark McGovern, who invited her to contribute as the Center. “Mark told me about his big dream for C-DIAS,” she recalled. “I was excited to be in a room where people were thinking big-picture about solutions.”
At C-DIAS, Crable found her place in the Policy and Financing Core, where she focuses on how policy design and insurance structures affect access to addiction treatment. “Many of our biggest challenges stem from poorly designed or poorly implemented health policies,” she said. “I want to make sure high-quality evidence about substance use treatment and harm reduction is one of the key inputs policymakers consider.” She added, “I love that the Policy and Financing Core brings together different methodological perspectives from economists and policy experts – interdisciplinary thinking leads to creative ideas.”
Rethinking Policy Implementation
Crable’s work often explores how evidence is used—or ignored—in policymaking processes. She points to Oregon’s Measure 110, where parts of the policy were repealed before full implementation. “We see that all the time,” she said. “Policies get declared failures before they’ve even had a chance to work. We need more rigorous and realistic ways to evaluate policy implementation.”
Her interdisciplinary research seeks to bridge that gap – leveraging health law, political science, dissemination and implementation science approaches. In 2025 she received a NIDA Avenir Award to develop a new methodology for understanding different policymakers’ evidence use styles for substance use and HIV relevant policy issues. She also leads the PolicyWISE Study, a national project examining why coverage for medications for opioid use disorder varies across Medicaid and CHIP programs. Early findings suggest that stigma and misinformation contribute to inconsistencies in coverage, especially for youth.
As co-investigator on the RESCUE project, she helps adapt harm-reduction simulation models to each state’s context. “You can’t just hand a model to a health department and expect it to work,” she said. “What’s effective in Rhode Island might be impossible in Missouri. We are using dissemination science principles and discourse analysis to tailor our messaging about and inform the content of the simulation models.”
Advice for Future Leaders
Crable urges early-career researchers to engage directly with the policy world. “Show up in policymaking spaces,” she said. “Listen to what decision-makers are actually dealing with right now so you can make sure your evidence speaks to the questions they’re being asked.”
When she’s not analyzing health policy, Crable finds balance outdoors. “When I moved to Southern California, I thought I’d get good at surfing,” she laughed. “I didn’t—but I do enjoy hiking new places and finding great live music. I’m a ’90s kid, so give me some alternative rock or a small jazz venue any day.”