Access to treatment for opioid use disorder (OUD) in rural areas within the United States remains a challenge. Providers must complete 8–24 h of training to obtain the Drug Addiction Treatment Act (DATA) 2000 waiver to have the legal authority to prescribe buprenorphine for OUD. Over the last 4 years, we executed five dissemination and implementation grants funded by the Agency for Healthcare Research and Quality to study and address barriers to providing Medications for Opioid Use Disorder Treatment (MOUD), including psychosocial supports, in rural primary care practices in different states. We found that obtaining the DATA 2000 waiver is just one component of meaningful treatment using MOUD, and that the waiver provides a one-time benchmark that often does not address other significant barriers that providers face daily. In this commentary, we summarize our initiatives and the common lessons learned across our grants and offer recommendations on how primary care providers can be better supported to expand access to MOUD in rural America.
Centers for Disease Control. Understanding the epidemic. Wide-ranging online data for epidemiologic research (WONDER) Web site. https://www.cdc.gov/drugoverdose/epidemic/index.html. Published 2017. Accessed August 13, 2019.
3.
ChouR, KorthuisPT, WeimerM, . Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings. Rockville, MD: Agency for Healthcare Research and Quality (US); 2016.
4.
World Health Organization Department of Mental Health Substance Abuse.Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence. Geneva, Switzerland: World Health Organization; 2009.
GhertnerR.US trends in the supply of providers with a waiver to prescribe buprenorphine for opioid use disorder in 2016 and 2018. Drug Alcohol Depend. 2019;204:107527.
7.
AndrillaCHA, CoulthardC, PattersonDG.Prescribing practices of rural physicians waivered to prescribe buprenorphine. Am J Prev Med. 2018; 54(6 Suppl 3):S208–S214.
8.
U.S. Department of Health and Human Services. 2014 Buprenorphine Summit, Report of Proceedings. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2014.
LevinFR, BisagaA, SullivanMA, WilliamsAR, Cates‐WesselK.A review of a national training initiative to increase provider use of MAT to address the opioid epidemic. Am J Addict. 2016;25(8):603–609.
CochranG, ColeES, WarwickJ, . Rural access to MAT in Pennsylvania (RAMP): a hybrid implementation study protocol for medication assisted treatment adoption among rural primary care providers. Addict Sci Clin Pract. 2019;14(1):25.
16.
SheaCM, GertnerAK, GreenSL.Barriers and perceived usefulness of an ECHO intervention for office-based buprenorphine treatment for opioid use disorder in North Carolina: a qualitative study. Subst Abus. 2021;42(1):54–11.
17.
SalvadorJG, BhattSR, JacobsohnVC, . Feasibility and acceptability of an online ECHO intervention to expand access to medications for treatment of opioid use disorder, psychosocial treatments and supports. Substance Abuse. 2020;1–8.doi: 10.1080/08897077.2020.1806184.
GordonAJ, DrexlerK, HawkinsEJ, . Stepped Care for Opioid Use Disorder Train the Trainer (SCOUTT) initiative: expanding access to medication treatment for opioid use disorder within Veterans Health Administration facilities. Subst Abus. 2020;41(3):275–282.
20.
AroraS, ThorntonK, MurataG, . Outcomes of treatment for hepatitis C virus infection by primary care providers. N Engl J Med. 2011;364(23):2199–2207.
21.
OberAJ, WatkinsKE, HunterSB, LampK, LindM, SetodjiCM.An organizational readiness intervention and randomized controlled trial to test strategies for implementing substance use disorder treatment into primary care: SUMMIT study protocol. Implement Sci. 2015;10:66.
22.
HagedornH, KennyM, GordonAJ, . Advancing pharmacological treatments for opioid use disorder (ADaPT-OUD): protocol for testing a novel strategy to improve implementation of medication-assisted treatment for veterans with opioid use disorders in low-performing facilities. Addict Sci Clin Pract. 2018;13(1):25.
23.
PolydorouS, GundersonEW, LevinFR.Training physicians to treat substance use disorders. Curr Psychiatry Rep. 2008;10(5):399–404.
24.
HutchinsonE, CatlinM, AndrillaCHA, BaldwinL-M, RosenblattRA.Barriers to primary care physicians prescribing buprenorphine. Ann Fam Med. 2014;12(2):128–133.
25.
McCartyD, RieckmannT, GreenC, GallonS, KnudsenJ.Training rural practitioners to use buprenorphine: using The Change Book to facilitate technology transfer. J Subst Abuse Treat. 2004;26(3):203–208.
26.
WalleyAY, AlperenJK, ChengDM, . Office-based management of opioid dependence with buprenorphine: clinical practices and barriers. J Gen Intern Med. 2008;23(9):1393–1398.
FrankJW, WakemanSE, GordonAJ.No end to the crisis without an end to the waiver. Subst Abus. 2018;39(3):263–265.
29.
HuntJB, CurranG, KramerT, . Partnership for implementation of evidence-based mental health practices in rural federally qualified health centers: theory and methods. Prog Community Health Partnersh. 2012;6(3):389–398.
30.
NetherlandJ, BotskoM, EganJE, Factors affecting willingness to provide buprenorphine treatment. J Subst Abuse Treat. 2009;36(3):244–251.
31.
BarryDT, IrwinKS, JonesES, . Integrating buprenorphine treatment into office-based practice: a qualitative study. J Gen Intern Med. 2009;24(2):218–225.
32.
LaBelleCT, HanSC, BergeronA, SametJH.Office-based opioid treatment with buprenorphine (OBOT-B): statewide implementation of the Massachusetts collaborative care model in community health centers. J Subst Abuse Treat. 2016;60:6–13.
33.
DiPieroA, DorrDA, KelsoC, BowenJL.Integrating systematic chronic care for diabetes into an academic general internal medicine resident-faculty practice. J Gen Intern Med. 2008;23(11):1749–1756.
34.
HuntJS, SiemienczukJ, PapeG, . A randomized controlled trial of team-based care: impact of physician-pharmacist collaboration on uncontrolled hypertension. J Gen Intern Med. 2008;23(12):1966–1972.
35.
AlfordDP, LaBelleCT, KretschN, . Collaborative care of opioid-addicted patients in primary care using buprenorphine: five-year experience. Arch Intern Med. 2011;171(5):425–431.
36.
Substance Abuse and Mental Health Services Administration. Treatment Episode Data Set (TEDS): 2005–2015. Rockville, MD: National Admissions to Substance Abuse Treatment Services; 2017.
37.
ColeES, DiDomenicoE, CochranG, . The role of primary care in improving access to medication-assisted treatment for rural medicaid enrollees with opioid use disorder. J Gen Intern Med. 2019;34(6):936–943.
