Influences upon the Decision to Adapt Office-Based Buprenorphine Treatment in Rural Settings: A Qualitative Study

Grants and Contracts Details

Description

With the current and growing opioid epidemic in the US, there is an urgent need to ensure sufficient access to evidence-based treatments for opioid use disorder (OUD). Medication-assisted treatment (MAT) with buprenorphine provides an outpatient option that can be done in a range of settings, including primary care. Physicians can become certified to prescribe buprenorphine for a set number of patients (up to 100) via the DEA DATA 2000 waiver option. Despite the considerable need, this evidence-based treatment has not been widely adopted and geographic disparities exist in the supply of waivered physicians. While previous studies have identified some correlates of this supply, such as state policies and availability of health insurance, these have been largely observational studies. There is a growing consensus that more research is needed to understand the full range of influences upon buprenorphine prescribing practices and the extent and nature of buprenorphine treatment, particularly in rural settings. We propose to conduct a qualitative study to examine the current status of buprenorphine prescribing practices and accessibility in two states with highly rural populations, Arkansas (where there are low numbers of buprenorphine waivered physicians per capita but where the opioid epidemic is not yet severe) and Kentucky (where there is a higher number of waivered physicians per capita and the opioid epidemic is critical). This work is a crucial first step in order to develop a larger subsequent study in which we will test implementation strategies to increase the adoption of buprenorphine treatment in both states. Aim 1: Conduct interviews among DATA-waivered physicians in Arkansas and Kentucky across a range of practice settings in order to examine the range of influences upon the decision to obtain the waiver to prescribe buprenorphine as well as the barriers and facilitators to providing buprenorphine treatment. Aim 2: Conduct interviews with non-waivered primary care providers in high-overdose, rural areas in both states to explore the perceived barriers and facilitators to providing buprenorphine treatment in rural primary care settings. The proposed study is both innovative and timely; no studies to date have included an in-depth qualitative examination of the experiences of clinicians on the front lines of the opioid epidemic in the rural South about their perceived barriers and facilitators to prescribing buprenorphine and/or expanding its use in rural areas most affected by the epidemic. An important aspect of the proposed study is the inclusion of two states in different stages of the opioid epidemic: Arkansas, where the burden of opioid related morbidity and mortality has not yet been fully realized and Kentucky, where morbidity and mortality resultant from opioid use have reached unprecedented levels. In addition, the proposed study is an important first step in understanding the current landscape of buprenorphine treatment in rural states such as Arkansas and Kentucky and has significant implications for other rural states in the south seeking to expand access to buprenorphine treatment.
StatusFinished
Effective start/end date6/15/185/30/20

Funding

  • University of Arkansas Medical Sciences: $71,177.00

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