“You are not clean until you're not on anything”: Perceptions of medication-assisted treatment in rural Appalachia

Richard, Emma L.; Schalkoff, Christine A.; Piscalko, Hannah M.; Brook, Daniel; Sibley, Adams L; Lancaster, Kathryn E.; Miller, William C.; Go, Vivian F.

doi:10.1016/j.drugpo.2020.102704

Cited by 84 publications

(71 citation statements)

References 40 publications

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“…In addition, we identified 2 studies of addiction counselors (who treat patients with OUD but are not responsible for prescribing medication), 10,32 1 study of community corrections employees, 47 and 1 study of a mix of healthcare professionals, substance use treatment providers, law enforcement agents, and judicial officials. 43 Eleven studies evaluated system-level barriers and facilitators to OUD medication use. 16, 20, 25, 33-36, 40, 42, 44, 48 All studies examined barriers and facilitators to use of buprenorphine; five also discussed naltrexone.…”

Section: Resultsmentioning

confidence: 99%

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Barriers and Facilitators to the Use of Medications for Opioid Use Disorder: a Rapid Review

et al. 2020

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Section: Resultsmentioning

confidence: 99%

“…16, 20, 25, 33-36, 40, 42, 44, 48 All studies examined barriers and facilitators to use of buprenorphine; five also discussed naltrexone. 11,25,39,41,43 Half of studies (22 studies, 55%) met our minimum quality criteria (Appendix C).…”

Section: Resultsmentioning

confidence: 99%

Barriers and Facilitators to the Use of Medications for Opioid Use Disorder: a Rapid Review

et al. 2020

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“…In the current substance use epidemic, drug use has significantly affected rural populations, particularly in states like Ohio, Kentucky, West Virginia, and New Hampshire [ 24 ]. Rural areas may have substantial stigma toward medication for OUD compared to urban areas [ 25 ]. This stigma of addiction may decrease the willingness of physicians to obtain the waiver to prescribe office-based buprenorphine in the absence of a significant epidemic [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

The Relationship Between Hepatitis C Virus Rates and Office-Based Buprenorphine Access in Ohio

Brook

Hetrick

Chettri

et al. 2021

Open Forum Infectious Diseases

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Background The United States is experiencing an epidemic of hepatitis C virus (HCV) infections due to injection drug use, primarily of opioids and predominantly in rural areas. Buprenorphine, a medication for opioid use disorder, may indirectly prevent HCV transmission. We assessed the relationship of HCV rates and office-based buprenorphine prescribing in Ohio. Methods We conducted an ecological study of the county-level (n = 88) relationship between HCV case rates and office-based buprenorphine prescribing in Ohio. We fit adjusted negative binomial models between the county-level acute and total HCV incidence rates during 2013–2017 and 1) the number of patients in each county that could be served by office-based buprenorphine (prescribing capacity) and 2) the number served by office-based buprenorphine (prescribing frequency) from January–March, 2018. Results For each 10% increase in acute HCV rate, office-based buprenorphine prescribing capacity differed by 1% (95% CI: –1%, 3%). For each 10% increase in total HCV rate, office-based buprenorphine prescribing capacity was 12% (95% CI: 7%, 17%) higher. For each 10% increase in acute HCV rate, office-based buprenorphine prescribing frequency was 1% (95% CI: –1%, 3%) higher. For each 10% increase in total HCV rate, office-based buprenorphine prescribing frequency was 14% (95% CI: 7%, 20%) higher. Conclusions Rural counties in Ohio have less office-based buprenorphine and higher acute HCV rates versus urban counties, but a similar relationship between office-based buprenorphine prescribing and HCV case rates. To adequately prevent and control HCV rates, certain rural counties may need more office-based buprenorphine prescribing in areas with high HCV case rates.

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“…Increased financial support from federal Medicaid and state-level Medicaid Managed Care Organizations (MCOs) should be pursued as it can improve access to MOUD for several rural patients and help them achieve and sustain sobriety [31]. In addition to this major financial barrier, other challenges shared by rural physicians are lack of a physician support network, lack of adequate clinic staff who were trained on caring for patients with OUD, a need to address mental health concerns through additional counseling, time restraints, legal regulations, stigma, and concerns over buprenorphine diversion [30,[32][33][34][35].…”

Section: Current State Changes and Challenges Of Buprenorphine Prescribing In Rural Areasmentioning

confidence: 99%

Implications of Increased Access to Buprenorphine for Medical Providers in Rural Areas: A Review of the Literature and Future Directions

Gregory¹,

Hill²,

Parker³

2021

Cureus

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Buprenorphine/Naloxone (Suboxone®) is an efficacious treatment for opioid use disorder (OUD) due to its more convenient dosing, superior safety profile, and decreased incidence of negative side effects when compared to other forms of medications for opioid use disorder (MOUD). In the United States, updated legislation in 2021 entitled, "The Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder", released by the Department of Health and Human Services, creates an exemption for the previously required Drug Addiction Treatment Act of 2000 (DATA) waiver for buprenorphine prescribing for clinicians. This legislation was born out of a need for making MOUD more accessible for patients living with OUD as rates of opioid-related deaths in the United States have continued to rise and have increased disproportionately during the time period of the COVID-19 pandemic. This legislation has the potential to improve access to MOUD across all geographic locations, but may have the most profound impact in rural areas where significant disparities and challenges still exist in patients’ ability to access buprenorphine. The purpose of this literature review is to 1) examine how MOUD prescribing has changed after previous legislation changes, 2) explore the current state of buprenorphine access for treatment of OUD in rural America, 3) detail existing barriers in patients' ability to access MOUD, and 4) discuss future directions and considerations as a result of new legislation. This literature review found several existing barriers to receiving MOUD such as increasing costs, insufficient education, significant stigma, and the need for more innovative methods of delivery. We also found that there is currently a large opportunity for growth in the number of rural clinicians able to prescribe buprenorphine, particularly in primary care, that may now occur as a result of this new legislation. Overall, this legislation has the potential to have a positive impact on combating OUD, especially in rural areas, and may be a critical step towards ending the current opioid epidemic in the United States as these described barriers are addressed.

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“You are not clean until you're not on anything”: Perceptions of medication-assisted treatment in rural Appalachia

Cited by 84 publications

References 40 publications

Barriers and Facilitators to the Use of Medications for Opioid Use Disorder: a Rapid Review

Barriers and Facilitators to the Use of Medications for Opioid Use Disorder: a Rapid Review

The Relationship Between Hepatitis C Virus Rates and Office-Based Buprenorphine Access in Ohio

Implications of Increased Access to Buprenorphine for Medical Providers in Rural Areas: A Review of the Literature and Future Directions

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