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The United States (U.S.) has experienced substantial increases in opioid use for more than two decades (Centers for Disease Control, 2021). The impacts of this growth have impacted rural areas where overdoses have risen drastically during this time and more often involve prescription opioids than in urban areas (Spencer et al., 2022). Medications for opioid use disorders (MOUDs) are highly underutilized in rural settings (Wu et al., 2016) due to lack of access, inadequate prescribing, and stigma (Lister et al., 2020). While attitudes and preferences of prescribing professionals with regards to treatments for OUD have been well-studied (e.g., Zuckerman et al., 2021), research on non-prescribing clinicians’ (NPCs) is less common. Among factors that deserve more attention is geographical context of practice. NPCs who practice in rural areas may have different OUD treatment preferences compared to those who practice in urban or suburban areas.
Methods:
A cross-sectional online survey of non-prescribing clinicians (NPCs) involved in the treatment of substance use disorders (SUDs) in the U.S. was conducted in 2019. Multiple recruitment methods were used to obtain a purposive sample of NPCs from a variety of geographical contexts across the nation. The survey assessed demographic and practice characteristics, exposure and training related to MOUDs, treatment orientation, treatment preferences for opioid use disorder (OUD), and attitudes toward MOUDs. Treatment preferences for OUD and attitudes toward MOUDs were compared based on rurality of practice location. A mediation model was tested to determine whether the relationship between rurality of practice setting and attitudes toward MOUDs is mediated by treatment orientation.
Results:
Among the 636 NPCs surveyed, respondents practicing in urban locations were most represented (44.3%), followed by suburban (34.4%) and rural settings (21.2%). Most favored a combination of MOUDs and psychosocial treatment. Compared to clinicians practicing in suburban or urban areas, self-identified rural clinicians were more likely to favor MOUDs alone as most effective and less likely to endorse a combination of MOUDs and psychosocial treatment (p = .040). Those practicing in rural settings were more oriented towards abstinence than those in urban settings (p = .014, d = .30). Although most NPCs were supportive of MOUDs overall, many endorsed misconceptions related to MOUDs. Rural clinicians were less likely to perceive MOUDs as being effective (p = .007, d = -.29) or acceptable compared to those in urban settings (p = .004, d = -.31). Results of a mediation analysis indicated that practicing in a rural location compared to in an urban location directly (β = .21, p = .032) and indirectly (β = .17, 95% CI: .05, .29) influenced attitudes toward MOUDs through an effect on treatment orientation.
Conclusions & Implications:
Results indicate that there is still a need for education and training about MOUDs among NPCs, particularly those who work in rural settings. More efforts are needed to educate rural clinicians about harm reduction principles and harm reduction strategies in general. In doing so, rural clinicians may be more receptive to contextualizing MOUDs an effective harm reduction strategy.