Context: Although New York State is a generous provider of substance-use treatment, people who ask for help have difficulty accessing services. If the laws are on the books, the agency is there to act, and the options are available, why is treatment so hard to get?

Methods: The authors conducted 87 open-ended interviews and observed local task force meetings in Sullivan County, New York. They open coded data, identifying key topics and themes.

Findings: Even though New York is a best-case scenario for treatment, people who seek help cannot always access it. The state sees the problem as a lack of beds or information about beds, but people on the ground face real barriers that make it difficult to get treatment, including the medical model of detoxification, admissions criteria, staff shortages, and other life complications.

Conclusions: Contrary to the policy literature, this article shows that policies may fail not because they are poorly designed or implemented but because the policy itself does not address the actual underlying problem. Furthermore, in the case of opioids, it shows how misplaced solutions can hide evidence of the underlying problem, exacerbating the very issue that policy makers want to fix.

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