Opioid use disorder treatment in rural settings: The primary care perspective

Valerie S Harder¹, Andrea C Villanti², Sarah H Heil³, M Lindsey Smith⁴, Diann E Gaalema³, Marjorie C Meyer⁵, Nathaniel H Schafrick⁶, Stacey C Sigmon³

Affiliations

¹ Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychiatry, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Pediatrics, Robert Larner, M.D. College of Medicine, University of Vermont, S-253 Given Courtyard, 89 Beaumont Avenue, Burlington, VT 05401, USA. Electronic address: vharder@uvm.edu.
² Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychiatry, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Vermont Center on Behavior and Health, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA.
³ Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychiatry, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Vermont Center on Behavior and Health, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychological Science, University of Vermont, 2 Colchester Ave., Burlington, VT 05401, USA.
⁴ Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Cutler Institute for Health and Social Policy, Muskie School of Public Service, University of Southern Maine, 34 Bedford St., Portland, ME 04104, USA.
⁵ Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, Robert Larner, M.D. College of Medicine, University of Vermont, 111 Colchester Ave, Main Campus, East Pavilion, Level 4, Burlington, VT 05401, USA.
⁶ Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA.

PMID: 34411588
PMCID: PMC8591995
DOI: 10.1016/j.ypmed.2021.106765

Opioid use disorder treatment in rural settings: The primary care perspective

Valerie S Harder et al. Prev Med. 2021 Nov.

. 2021 Nov;152(Pt 2):106765.

doi: 10.1016/j.ypmed.2021.106765. Epub 2021 Aug 16.

Authors

Valerie S Harder¹, Andrea C Villanti², Sarah H Heil³, M Lindsey Smith⁴, Diann E Gaalema³, Marjorie C Meyer⁵, Nathaniel H Schafrick⁶, Stacey C Sigmon³

Affiliations

¹ Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychiatry, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Pediatrics, Robert Larner, M.D. College of Medicine, University of Vermont, S-253 Given Courtyard, 89 Beaumont Avenue, Burlington, VT 05401, USA. Electronic address: vharder@uvm.edu.
² Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychiatry, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Vermont Center on Behavior and Health, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA.
³ Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychiatry, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Vermont Center on Behavior and Health, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Psychological Science, University of Vermont, 2 Colchester Ave., Burlington, VT 05401, USA.
⁴ Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Cutler Institute for Health and Social Policy, Muskie School of Public Service, University of Southern Maine, 34 Bedford St., Portland, ME 04104, USA.
⁵ Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA; Department of Obstetrics, Gynecology and Reproductive Sciences, Robert Larner, M.D. College of Medicine, University of Vermont, 111 Colchester Ave, Main Campus, East Pavilion, Level 4, Burlington, VT 05401, USA.
⁶ Center on Rural Addiction, Robert Larner, M.D. College of Medicine, University of Vermont, 1 S. Prospect St., Burlington, VT, 05401, USA.

PMID: 34411588
PMCID: PMC8591995
DOI: 10.1016/j.ypmed.2021.106765

Abstract

Despite the efficacy of medications for treating opioid use disorder (OUD), they are underutilized, especially in rural areas. Our objectives were to determine the association between primary care practitioners (PCPs) rurality and concerns for patient substance use, and to identify factors associated with PCP comfort treating OUD, focusing on barriers to treatment. We developed a web-based survey completed by 116 adult-serving PCPs located in Vermont's rural and non-rural counties between April-August 2020. The instrument included PCP-identified concerns for substance use among patients, barriers to treating patients with OUD, and current level of comfort treating patients with OUD. On a scale from 0 to 10, rural PCPs reported higher concern for heroin (mean difference; Mdiff = 1.38, 95% CI: 0.13 to 2.63), fentanyl (Mdiff = 1.52, 95% CI: 0.29 to 2.74), and methamphetamine (Mdiff = 1.61, 95% CI: 0.33 to 2.90) use among patients compared to non-rural PCPs, and practitioners in both settings expressed high concern regarding their patients' use of tobacco (7.6 out of 10) and alcohol (7.0 out of 10). There was no difference in reported comfort in treating patients with OUD among rural vs. non-rural PCPs (Mdiff = 0.65, 95%CI: 0.17 to 1.46; P = 0.119), controlling for higher comfort among male PCPs and those waivered to prescribe buprenorphine (Ps < 0.05). Lack of training/experience and medication diversion were PCP-identified barriers associated with less comfort treating OUD patients, while time constraints was associated with more comfort (Ps < 0.05). Taken together, these data highlight important areas for dissemination of evidence-based training, support, and resources to expand OUD treatment capacity in rural communities.

Keywords: Buprenorphine; Opioid agonist treatment; Opioid use disorder; Opioids; Primary care practitioners; Rural; Treatment barriers and comfort.

PubMed Disclaimer

Conflict of interest statement

Declaration of Competing Interest

None.

The authors have no conflicts of interest to disclose.

Figures

**Fig. 1.**
Map of designated rural (shaded darker) and non-rural counties in Vermont.

See this image and copyright information in PMC

References

1. Andraka-Christou B, Capone MJ, 2018. A qualitative study comparing physician-reported barriers to treating addiction using buprenorphine and extended-release naltrexone in U.S. office-based practices. Int. J. Drug. Policy 54, 9–17. - PubMed
1. Andrilla CHA, Coulthard C, Larson EH, 2017. Barriers rural physicians face prescribing buprenorphine for opioid use disorder. Ann. Fam. Med. 15 (4), 359–362. - PMC - PubMed
1. Andrilla CHA, Moore TE, Patterson DG, Larson EH, 2019. Geographic distribution of providers with a DEA waiver to prescribe buprenorphine for the treatment of opioid use disorder: a 5-year update. J. Rural. Health 35 (1), 108–112. - PubMed
1. Ball JC, Ross A, 1991. The Effectiveness of Methadone Maintenance Treatment: Patients, Programs, Services, and Outcome. Springer-Verlag Publishing, New York, NY, US.
1. Blevins CE, Rawat N, Stein MD, 2018. Gaps in the substance use disorder treatment referral process: provider perceptions. J. Addict. Med. 12 (4), 273–277. - PMC - PubMed

Publication types

Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Opioid use disorder treatment in rural settings: The primary care perspective

Affiliations

Opioid use disorder treatment in rural settings: The primary care perspective

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Substances

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous