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Background  The US 21st Century Cures Act provided $7.5 billion in grant funding to states and territories for evidence-based responses to the opioid epidemic. Currently, little is known about optimal strategies for sustaining these programs beyond this start-up funding.    Methods  Using an inductive, conventional content analysis, we conducted key informant interviews with former and current state leaders ( n  = 16) about barriers/facilitators to sustainment and strategies for sustaining time-limited grants.    Results  Financing and reimbursement, service integration, and workforce capacity were the most cited barriers to sustainment. Status in state government structure, public support, and spending flexibility were noted as key facilitators. Effective levers to increase chances for sustainment included strong partnerships with other state agencies, workforce and credentialing changes, and marshalling advocacy through public awareness campaigns.    Conclusions  Understanding the strategies that leaders have successfully used to sustain programs in the past can inform how to continue future time-limited, grant-funded initiatives.

The prospects for sustaining evidence-based responses to the US opioid epidemic: state leadership perspectives