Increasing North Carolina’s Workforce Capacity for Prescribing Buprenorphine Products

Abstract

background Inadequate access to opioid use disorder (OUD) treatment is a public health concern. Rates of opioid-related poisoning deaths are increasing in North Carolina and access to OUD treatment is especially sparse in rural areas. DEA-X-waivered providers that can prescribe buprenorphine as a medication for opioid use disorder (MOUD) play an essential role in treating OUD. Increased workforce capacity to treat OUD in an evidence-based, equitable, and patient-centered way is needed. Gaps persist in continuing professional education and academic training. methods Description of an interdisciplinary training team effort to engage medical residencies and advanced practice provider (APP) programs across North Carolina in a set of subsidized trainings about substance use disorder treatment and medication-assisted treatment (MAT), with the goal of increasing capacity to administer MOUD, based on each program's needs. Uptake was independently evaluated. results Engagement exceeded initial goals: 72 unique trainings related to MAT were administered to 1512 providers from 30 residency and 7 APP programs. By the end of the grant period, 902 participants completed a training required to obtain a DEA-X waiver. Evaluation of training uptake identified facilitators and barriers specific to residents and APP trainees. limitations Limitations included difficulty coordinating training with existing didactic and clinical schedules during the project time frame and challenges identifying implementation leaders at training sites. conclusion This project highlights a successful and potentially replicable approach to offering structured MAT capacity-building training in combination with technical assistance (TA) within medical education programs.

Factors in rural community buprenorphine dispensing

“…These areas had experienced higher overdose death rates than the state overall in the prior years [ 36 ] and public health departments in two of the counties had recently begun prescribing buprenorphine products. All are located where state and grant-funded efforts sought to increase providers eligible to apply for a DEA X-waiver to prescribe buprenorphine [ 6 , 37 ].…”

“…Despite higher rural overdose rates [ 3 , 4 , 5. , 6 ], treatment access is limited. Buprenorphine is an evidence-based approach for treating opioid use disorder (OUD) and reducing overdoses [ 7 , 8 ].…”

Opioid Use Disorder Practice by Licensure Category in North Carolina

“…I ncreasing access to medications for opioid use disorder (MOUD) is an effective measure for addressing rising opioid-related deaths [1]. However, the limited supply of providers eligible to prescribe MOUD has been implicated as a barrier to treating opioid use disorder (OUD) despite increases in insurance coverage and an expansion of training [2,3]. Beginning with the passage of the Comprehensive Addiction and Recovery Act of 2016, nurse practitioners, certified nurse midwives, and physician assistants, collectively referred to as advanced practice providers (APPs), have had a pivotal and cost-effective role in addressing these service gaps related to treating OUD and other substance use disorders (SUD), particularly in rural areas [4][5][6].…”