The Buprenorphine Prescribing Support Program for Rural Primary Care

About This Grant

Project Summary/Abstract: Our community-engaged study will test whether a brief prescribing support program, paired with mentorship from peer health care professionals can expand access to buprenorphine in rural communities and improve clinical outcomes in people with opioid use disorder (OUD). Despite its efficacy, buprenorphine is vastly underused in rural settings and is not often prescribed because of stigma towards the medication, lack of training, and limited opportunities for peer mentorship. Primary care professionals (PCPs) are an ideal group to increase buprenorphine availability. Primary care is a less stigmatizing care setting, and PCPs can also provide other needed medical care as well as infectious disease screening. We co-created the Buprenorphine Prescribing Support Program (BPSP) with rural PCPs in Ohio and determined feasibility in a pilot clinical trial of 29 Federally Qualified Health Centers. The BPSP pairs clinical training on buprenorphine with stigma reduction to increase confidence prescribing the medication. PCPs completing the program also receive long-term prescribing support since mentorship is limited in small, rural primary care clinics. Although we found encouraging trends in our feasibility trial, the pilot was not powered to detect changes in adoption. The BPSP needs tested in a fully powered, hybrid type 3 cluster randomized implementation effectiveness trial to determine if the program improves implementation as well as clinical outcomes for people with OUD. We have 3 aims: 1) Implementation: we will assess the impact of the BPSP on buprenorphine adoption and reach in a cluster randomized hybrid type 3 implementation effectiveness trial in 40 rural primary care clinics in Ohio and West Virginia; 2) Clinical Effectiveness: We will determine the long-term impact of the BPSP on clinical outcomes, including patient retention in care, remission from opioid use; and infectious disease status; and 3) Determinants of Implementation, Scale-up, and Sustainment: Using in-depth interviews with PCPs, staff, and clinic leadership, we will explore BPSP implementation barriers and facilitators, identify any future tailoring needs, and select appropriate strategies for scale up and dissemination beyond rural Ohio and West Virginia. By integrating tailored prescribing support within rural primary care to build the buprenorphine prescriber workforce and expand access to medication that can reduce overdose, our study directly aligns with the objectives outlined in RFA-DA-25-077 to end the overdose crisis and the associated NOSI (NOT-DA-23- 008) to build the addiction care workforce. Our study will advance both implementation and intervention science. The inclusion of large and small rural clinics in two states will ensure the findings are applicable to primary care clinics that serve rural areas nationwide. The BPSP has the potential to be a low-cost, sustainable, and scalable program that will improve buprenorphine access in rural communities.