Training Needs of Opioid Prevention, Treatment, and Recovery Urban-Based and Rural-Based Providers in Rural Washington

Background and Purpose: Washington state is amid an opioid overdose epidemic that has significantly impacted rural communities. Rural settings present unique challenges to addressing opioid misuse including geographic barriers and slow adoption of evidence-based approaches by providers. The purpose of this study is to identify training needs and gaps experienced by opioid prevention, treatment, and recovery providers serving rural Washington communities.

Methods: Washington-based opioid-related service providers (N=78) completed an online survey between July and September 2020 using expert sampling. Most participants described their work communities as rural (64%) or urban, but serving rural communities (32%). Participants’ work organizations focused on substance use prevention (29.3%), healthcare (21.3%), community-based education (12%), and substance use treatment (6.7%). Given the small sample size, two-sided fisher’s exact tests were used to compare rates of prior training received between rural providers and urban, but rural-serving providers across a range of opioid prevention, treatment, and recovery training topics.

Results: Opioid-related service providers expressed similar levels of interest in training topics across the spectrum of prevention, treatment, and recovery. However, rates of prior training differed significantly between geographic settings, with rural providers receiving significantly fewer training opportunities related to opioid treatment and recovery compared to urban, but rural-serving providers, including training in treatment and recovery services for individuals involved in the criminal justice system (19.1% vs. 47.8%, p = .023) and workplace-based education on treatment and recovery (8.5% vs. 34.8%, p=.014). Conversely, rural providers reported significantly higher prior training opportunities related to opioid prevention compared to urban, but rural-serving providers, including training in availability of prevention programs for youth (57.4% vs. 26.1%, p = .021). Training on how to access funding for prevention was trending toward significance (36.2% vs. 13.0%, p = .053). Descriptive analyses indicated both groups desired more training in prevention, treatment, and recovery, with no significant differences between groups.

Conclusions and Implication: Despite serving the same rural patient population, findings suggest a discrepancy in training among opioid related-service providers based in urban and rural settings. Prevention, treatment, and recovery exist on a continuum, but are often siloed in training and practice. Disparate geographic foci result in inconsistent opioid responses for poorly resourced and significantly impacted rural communities.