Barriers to accessing medications for opioid use disorder among rural individuals

Anna M. Morenz; Robin M. Nance; L. Sarah Mixson; Judith Feinberg; Gordon Smith; P. Todd Korthuis; Mai T. Pho; Wiley D. Jenkins; Peter D. Friedmann; Thomas J. Stopka; Laura C. Fanucchi; William C. Miller; Vivian F. Go; Ryan Westergaard; David W. Seal; William A. Zule; Heidi M. Crane; Joseph A. Delaney; Judith I. Tsui

doi:10.1016/j.drugpo.2025.104805

Barriers to accessing medications for opioid use disorder among rural individuals

Anna M. Morenz
, Robin M. Nance
, L. Sarah Mixson
, Judith Feinberg
, Gordon Smith
, P. Todd Korthuis
, Mai T. Pho
, Wiley D. Jenkins
, Peter D. Friedmann
, Thomas J. Stopka
, Laura C. Fanucchi
, William C. Miller
, Vivian F. Go
, Ryan Westergaard
, David W. Seal
, William A. Zule
, Heidi M. Crane
, Joseph A. Delaney
, Judith I. Tsui

Research output: Contribution to journal › Article › peer-review

10 Scopus citations

Abstract

Background: Individuals with opioid use disorder living in rural areas face barriers to accessing medications for treatment (MOUD), including finding prescribing clinicians and difficulties with transportation. This study sought to describe self-reported barriers to MOUD access in rural areas and associations between desired MOUD type and barriers encountered or perceived. Methods: We performed a cross-sectional study of Rural Opioid Initiative participants who ever used opioids and sought MOUD treatment, who were surveyed from 2018 to 2020 about access to MOUD. Multivariable logistic regressions explored the association between MOUD type and barriers while controlling for age, gender, race, and study site. Results: Of 2906 participants who used opioids and sought MOUD, 826 (28.4 %) were unable to access MOUD. In logistic regression models, lack of transportation was a more common barrier for those seeking methadone versus sublingual buprenorphine (adjusted odds radio [aOR] 1.87, 95 % confidence interval (CI) 1.24–2.81). A long wait list was more common for those seeking injectable naltrexone than sublingual buprenorphine (aOR 1.68, 95 % CI 1.05–2.69). Lack of doctors or programs and affordability were more common for those seeking injectable versus sublingual buprenorphine (aOR 7.84, 95 % CI 4.87–12.63 and aOR 1.89, 95 % CI 1.26–2.83, respectively). Conclusions: Access barriers vary by MOUD type for rural individuals with OUD. Compared to sublingual buprenorphine, methadone access was hindered more by transportation difficulties, while injectable long-acting buprenorphine was hindered more by affordability and finding a doctor or program. These barriers highlight the need to de-regulate and expand locations for methadone access and prescribing, and to improve affordability and prescriber uptake of newer MOUDs, such as injectable buprenorphine.

Original language	English
Article number	104805
Journal	International Journal of Drug Policy
Volume	140
DOIs	https://doi.org/10.1016/j.drugpo.2025.104805
State	Published - Jun 2025

Bibliographical note

Publisher Copyright:
© 2025 Elsevier B.V.

Funding

This abstract is based upon data collected and/or methods developed as part of the Rural Opioid Initiative, a multi-site study with a common protocol which was developed collaboratively by investigators at eight research institutions and at the National Institute of Drug Abuse (NIDA), the Appalachian Regional Commission (ARC), the Centers for Disease Control and Prevention (CDC), and the Substance Abuse and Mental Health Services Administration (SAMHSA). Research presented in this publication is the result of secondary data harmonization and analysis and supported by grant U24DA048538 from NIDA. Primary data collection was supported by grants UG3DA044829/UH3DA044829, UG3DA044798/UH3DA044798, UG3DA044830/UH3DA044830, UG3DA044823/UH3DA044823, UG3DA044822/UH3DA044822, UG3DA044831/UH3DA044831, UG3DA044825, UG3DA044826/UH3DA044826, and U24DA044801 co-funded by NIDA, ARC, CDC, and SAMHSA. The authors thank the other ROI investigators and their teams, the ROI Executive Steering Committee chair, Dr. Holly Hagan, the NIDA Science Officer, Dr. Richard Jenkins, and particularly, the participants of the individual ROI studies for their valuable contributions. A full list of participating ROI investigators and institutions can be found on the ROI website at http://ruralopioidinitiative.org/studies.html. During this project, Dr. Morenz was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number T32DK070555. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Funders	Funder number
Centers for Disease Control and Prevention
National Institute of Diabetes and Digestive and Kidney Diseases
Appalachian Regional Commission
Author National Institute on Drug Abuse DA031791 Mark J Ferris National Institute on Drug Abuse DA006634 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA026117 Mark J Ferris National Institute on Alcohol Abuse and Alcoholism AA028162 Elizabeth G Pitts National Institute of General Medical Sciences GM102773 Elizabeth G Pitts Peter McManus Charitable Trust Mark J Ferris National Institute on Drug Abuse
Substance Abuse and Mental Health Services Administration	UG3DA044829/UH3DA044829, UG3DA044798/UH3DA044798, UG3DA044826/UH3DA044826, UG3DA044823/UH3DA044823, UG3DA044831/UH3DA044831, U24DA048538, UG3DA044822/UH3DA044822, UG3DA044830/UH3DA044830, UG3DA044825, U24DA044801
National Institutes of Health (NIH)	T32DK070555

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Affordability
Barriers to opioid use disorder treatment
Medications for opioid use disorder
Rural healthcare
Transportation

ASJC Scopus subject areas

Medicine (miscellaneous)
Health Policy

Access to Document

10.1016/j.drugpo.2025.104805

Cite this

Morenz, A. M., Nance, R. M., Mixson, L. S., Feinberg, J., Smith, G., Korthuis, P. T., Pho, M. T., Jenkins, W. D., Friedmann, P. D., Stopka, T. J., Fanucchi, L. C., Miller, W. C., Go, V. F., Westergaard, R., Seal, D. W., Zule, W. A., Crane, H. M., Delaney, J. A., & Tsui, J. I. (2025). Barriers to accessing medications for opioid use disorder among rural individuals. International Journal of Drug Policy, 140, Article 104805. https://doi.org/10.1016/j.drugpo.2025.104805

@article{31ad3af8326a481083a202898b79afe8,

title = "Barriers to accessing medications for opioid use disorder among rural individuals",

abstract = "Background: Individuals with opioid use disorder living in rural areas face barriers to accessing medications for treatment (MOUD), including finding prescribing clinicians and difficulties with transportation. This study sought to describe self-reported barriers to MOUD access in rural areas and associations between desired MOUD type and barriers encountered or perceived. Methods: We performed a cross-sectional study of Rural Opioid Initiative participants who ever used opioids and sought MOUD treatment, who were surveyed from 2018 to 2020 about access to MOUD. Multivariable logistic regressions explored the association between MOUD type and barriers while controlling for age, gender, race, and study site. Results: Of 2906 participants who used opioids and sought MOUD, 826 (28.4 \%) were unable to access MOUD. In logistic regression models, lack of transportation was a more common barrier for those seeking methadone versus sublingual buprenorphine (adjusted odds radio [aOR] 1.87, 95 \% confidence interval (CI) 1.24–2.81). A long wait list was more common for those seeking injectable naltrexone than sublingual buprenorphine (aOR 1.68, 95 \% CI 1.05–2.69). Lack of doctors or programs and affordability were more common for those seeking injectable versus sublingual buprenorphine (aOR 7.84, 95 \% CI 4.87–12.63 and aOR 1.89, 95 \% CI 1.26–2.83, respectively). Conclusions: Access barriers vary by MOUD type for rural individuals with OUD. Compared to sublingual buprenorphine, methadone access was hindered more by transportation difficulties, while injectable long-acting buprenorphine was hindered more by affordability and finding a doctor or program. These barriers highlight the need to de-regulate and expand locations for methadone access and prescribing, and to improve affordability and prescriber uptake of newer MOUDs, such as injectable buprenorphine.",

keywords = "Affordability, Barriers to opioid use disorder treatment, Medications for opioid use disorder, Rural healthcare, Transportation",

author = "Morenz, \{Anna M.\} and Nance, \{Robin M.\} and Mixson, \{L. Sarah\} and Judith Feinberg and Gordon Smith and Korthuis, \{P. Todd\} and Pho, \{Mai T.\} and Jenkins, \{Wiley D.\} and Friedmann, \{Peter D.\} and Stopka, \{Thomas J.\} and Fanucchi, \{Laura C.\} and Miller, \{William C.\} and Go, \{Vivian F.\} and Ryan Westergaard and Seal, \{David W.\} and Zule, \{William A.\} and Crane, \{Heidi M.\} and Delaney, \{Joseph A.\} and Tsui, \{Judith I.\}",

note = "Publisher Copyright: {\textcopyright} 2025 Elsevier B.V.",

year = "2025",

month = jun,

doi = "10.1016/j.drugpo.2025.104805",

language = "English",

volume = "140",

}

Morenz, AM, Nance, RM, Mixson, LS, Feinberg, J, Smith, G, Korthuis, PT, Pho, MT, Jenkins, WD, Friedmann, PD, Stopka, TJ, Fanucchi, LC, Miller, WC, Go, VF, Westergaard, R, Seal, DW, Zule, WA, Crane, HM, Delaney, JA & Tsui, JI 2025, 'Barriers to accessing medications for opioid use disorder among rural individuals', International Journal of Drug Policy, vol. 140, 104805. https://doi.org/10.1016/j.drugpo.2025.104805

TY - JOUR

T1 - Barriers to accessing medications for opioid use disorder among rural individuals

AU - Morenz, Anna M.

AU - Nance, Robin M.

AU - Mixson, L. Sarah

AU - Feinberg, Judith

AU - Smith, Gordon

AU - Korthuis, P. Todd

AU - Pho, Mai T.

AU - Jenkins, Wiley D.

AU - Friedmann, Peter D.

AU - Stopka, Thomas J.

AU - Fanucchi, Laura C.

AU - Miller, William C.

AU - Go, Vivian F.

AU - Westergaard, Ryan

AU - Seal, David W.

AU - Zule, William A.

AU - Crane, Heidi M.

AU - Delaney, Joseph A.

AU - Tsui, Judith I.

PY - 2025/6

Y1 - 2025/6

N2 - Background: Individuals with opioid use disorder living in rural areas face barriers to accessing medications for treatment (MOUD), including finding prescribing clinicians and difficulties with transportation. This study sought to describe self-reported barriers to MOUD access in rural areas and associations between desired MOUD type and barriers encountered or perceived. Methods: We performed a cross-sectional study of Rural Opioid Initiative participants who ever used opioids and sought MOUD treatment, who were surveyed from 2018 to 2020 about access to MOUD. Multivariable logistic regressions explored the association between MOUD type and barriers while controlling for age, gender, race, and study site. Results: Of 2906 participants who used opioids and sought MOUD, 826 (28.4 %) were unable to access MOUD. In logistic regression models, lack of transportation was a more common barrier for those seeking methadone versus sublingual buprenorphine (adjusted odds radio [aOR] 1.87, 95 % confidence interval (CI) 1.24–2.81). A long wait list was more common for those seeking injectable naltrexone than sublingual buprenorphine (aOR 1.68, 95 % CI 1.05–2.69). Lack of doctors or programs and affordability were more common for those seeking injectable versus sublingual buprenorphine (aOR 7.84, 95 % CI 4.87–12.63 and aOR 1.89, 95 % CI 1.26–2.83, respectively). Conclusions: Access barriers vary by MOUD type for rural individuals with OUD. Compared to sublingual buprenorphine, methadone access was hindered more by transportation difficulties, while injectable long-acting buprenorphine was hindered more by affordability and finding a doctor or program. These barriers highlight the need to de-regulate and expand locations for methadone access and prescribing, and to improve affordability and prescriber uptake of newer MOUDs, such as injectable buprenorphine.

AB - Background: Individuals with opioid use disorder living in rural areas face barriers to accessing medications for treatment (MOUD), including finding prescribing clinicians and difficulties with transportation. This study sought to describe self-reported barriers to MOUD access in rural areas and associations between desired MOUD type and barriers encountered or perceived. Methods: We performed a cross-sectional study of Rural Opioid Initiative participants who ever used opioids and sought MOUD treatment, who were surveyed from 2018 to 2020 about access to MOUD. Multivariable logistic regressions explored the association between MOUD type and barriers while controlling for age, gender, race, and study site. Results: Of 2906 participants who used opioids and sought MOUD, 826 (28.4 %) were unable to access MOUD. In logistic regression models, lack of transportation was a more common barrier for those seeking methadone versus sublingual buprenorphine (adjusted odds radio [aOR] 1.87, 95 % confidence interval (CI) 1.24–2.81). A long wait list was more common for those seeking injectable naltrexone than sublingual buprenorphine (aOR 1.68, 95 % CI 1.05–2.69). Lack of doctors or programs and affordability were more common for those seeking injectable versus sublingual buprenorphine (aOR 7.84, 95 % CI 4.87–12.63 and aOR 1.89, 95 % CI 1.26–2.83, respectively). Conclusions: Access barriers vary by MOUD type for rural individuals with OUD. Compared to sublingual buprenorphine, methadone access was hindered more by transportation difficulties, while injectable long-acting buprenorphine was hindered more by affordability and finding a doctor or program. These barriers highlight the need to de-regulate and expand locations for methadone access and prescribing, and to improve affordability and prescriber uptake of newer MOUDs, such as injectable buprenorphine.

KW - Affordability

KW - Barriers to opioid use disorder treatment

KW - Medications for opioid use disorder

KW - Rural healthcare

KW - Transportation

UR - https://www.scopus.com/pages/publications/105002792051

UR - https://www.scopus.com/pages/publications/105002792051#tab=citedBy

U2 - 10.1016/j.drugpo.2025.104805

DO - 10.1016/j.drugpo.2025.104805

M3 - Article

C2 - 40252371

AN - SCOPUS:105002792051

SN - 0955-3959

VL - 140

JO - International Journal of Drug Policy

JF - International Journal of Drug Policy

M1 - 104805

ER -

Barriers to accessing medications for opioid use disorder among rural individuals

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

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Cite this