Expanding Medications for Opioid Use Disorder in Rural Primary Care

Oklahoma is among the states hardest hit by a combination of national trends in nonmedical uses of opioid prescription drugs, past-year heroin use, and opioid-related mortality. As a rural state, Oklahoma is challenged to identify and reach persons with unmet treatment needs despite ongoing state efforts to improve access to substance use disorder treatment services, promote awareness of the opioid epidemic and foster safe prescribing of opioid prescription drugs.

AIR recently led and evaluated a project for the Agency for Healthcare Research and Quality—Increasing Access to Medication-Assisted Treatment Among Rural Providers—to train rural Oklahoma primary care clinicians to identify and treat patients with opioid use disorders (OUD) using medications for opioid use disorder (MOUD), an evidence-based intervention that combines behavioral therapy and medication to treat substance use disorders. In partnership with the state, AIR developed, implemented, and evaluated an intervention to support primary care providers in four regions of rural Oklahoma to adopt MOUD through intensive provider training in the fundamentals of addiction medicine, practice facilitation, opportunities for case-based learning, and access to physician experts for tailored consultations.  

The AIR evaluation found that the intervention to train, certify, and mentor primary care providers to prescribe buprenorphine can successfully expand access to MOUD but may be tempered by obstacles at the provider, practice, system, and regulatory levels. Motivated, engaged providers with control over their practice or practice leadership support are likely to succeed with training and implementation while encountering manageable challenges with initial prescribing. Uncertainties about initiating treatment with the first patient and treating women who are pregnant are challenges that can be eased with the help of an experienced mentor. State-level requirements for supervisory oversight significantly restrict some mid-level providers from prescribing.