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This article is an examination of the language of recent large-scale education reform in England, New Zealand, and the Canadian provinces of Alberta and Manitoba. In each jurisdiction, we review both the official documents and the parliamentary debate around a set of major educational reforms, looking at both the similarities and differences between jurisdictions and at the overall nature of official discourse. Although some similar rhetoric was used in all four settings, we conclude that the differences in justifications were more significant than the commonalities. Our analysis supports a view of official rhetoric as being primarily symbolic and intended to create or support particular definitions of problems and solutions, but also as shaped by the historical context, institutional structure, and political culture of each setting.

Introduction Medication-assisted treatment (MAT) is an evidence-based therapy for opioid use disorder (OUD) that has not been fully implemented in rural areas due to patient, provider, and logistical barriers. Limited information is available on provider perceptions of barriers to MAT in rural Central Appalachia which has very high rates of OUD compared to the rest the United States. Purpose Determine perceived barriers for potential prescribers to using MAT, including buprenorphine, as part of treatment for OUD in West Virginia. Methods A 30-question, anonymous survey was sent to physicians, physician assistants and advanced practice registered nurses using an online link. Link was distributed through the WV Medicaid provider list, professional association and institutional contact lists, and social media. Comparisons were made by provider waivered or non-waivered status. Results Overall, 84% of waivered providers (n = 77) and only 8% of non-waivered providers (n = 341) indicated ever prescribing a form of MAT for OUD; 73% percent of waivered providers were currently prescribing MAT and accepting new patients with OUD. Only 4% of non-waivered providers were currently prescribing MAT and 21% were currently accepting new patients with OUD. Lack of available mental health and psychosocial support services and concerns about diversion or misuse of medication were the top perceived barriers to implementing MAT programs. Implications Implementing strategies to improve access to behavioral health care including telehealth and apps, provider training and addressing stigma around OUD treatment were identified as priorities that would help increase providers’ willingness to prescribe medications for OUD treatment.

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