Medications for Opioid Use Disorder in Rural United States: A Critical Review of the Literature, 2004-2021.

BACKGROUND: The opioid epidemic continues to be problematic in the United States (US). Medications for opioid use disorder (MOUD) are a commonly used evidence-based approach to treating affected individuals, but little is known about its use in the rural US. We reviewed published literature and summarized access, barriers, and approaches to MOUD delivery in rural areas. METHODS: We conducted a search using databases in EBSCOhost, such as Academic Search Complete, Medline, and APA PsycArticles, using a priori aims. Articles published after 2004 were included if they were cross-sectional, analyzed secondary data, collected quantitative or qualitative primary data, were longitudinal or reported intervention results. Studies were excluded if they were conducted outside the US or did not present data. RESULTS: A total of 13 articles met all criteria. Themes from the articles included increase in rural areas with waivered physicians able to prescribe buprenorphine, barriers to physician prescribing, waivered physicians choosing not to prescribe, and inability to assess quality of MOUD practices in rural US settings. CONCLUSIONS: Additional studies of MOUD delivery in rural areas are needed to help explicate themes found in this review. Having a stronger understanding of prescribers operating practices and program roll-out in rural areas may help address some identified barriers and deliver a stronger quality treatment practice for individuals with substance-use disorder.