Perceiving the Barriers to Prescribing Medications to Treat OUD in Rural Regions

Background: There are an insufficient number of clinicians prescribing lifesaving medication for addiction treatment (MAT) to combat the opioid crisis. Rural regions have especially been impacted by a rise in opioid use disorders (OUD), worsened by the Coronavirus Disease 2019 (COVID-19) pandemic, but with limited MAT prescribers available, few clinicians are treating patients with OUD. Clinicians from rural areas of Michigan participated in a Drug Addiction Treatment Act MAT waiver training to aid in managing OUD. A survey was distributed to understand the types of perceived barriers that exist to integrate MAT into practice.

Methods: Leveraging a partnership with the American Society of Addiction Medicine, MAT waiver training occurred on-site in April 2019 and via a virtual platform in April 2020 due to the COVID-19 pandemic. Upon receiving local IRB exemption, a 10-item subset of an internally developed survey was administered to a convenience sample of 35 clinicians who attended the MAT waiver training each year. The survey was given after completion of an accredited MAT waiver training session to specifically assess the perceptions on the barriers to incorporate MAT into clinical practice.


Results: In 2019, 16 clinicians completed the survey; 19 clinicians completed the survey in 2020, comprising a total of 29 physicians and 6 nurse practitioners/physician assistants. From a total of 10 barriers identified with incorporating MAT, six barriers had the greatest proportion identified including time constraints in clinic—87.5% in 2019 and 57.9% in 2020 (p-value 0.07), lack of specialty backup for complex problems—81.3% in 2019 and 68.4% in 2020 (p 0.46), lack of available mental health or psychosocial support services in the community—75.0% in 2019 and 36.8% in 2020 (p 0.02), concerns about diversion or misuse of MAT—68.8% in 2019 and 47.4% in 2020 (p 0.20), lack of confidence in managing OUD—56.2% in 2019 and 42.1% in 2020 (p 0.30), and financial/reimbursement concerns—43.8% in 2019 and 42.1% in 2020 (p 0.92). Two of these barriers achieved or approached statistical significance when comparing both years, and encompassed concerns over time and mental health access.

Conclusion: A large proportion identified substantial barriers to prescribing MAT to treat OUD. Perceptions of barriers in two areas decreased from 2019 to 2020: time constraints in practice and lack of access to mental health services support, which was an unexpected result. The perceived decrease in these two areas are challenging to discern during the COVID-19 pandemic. However, the other barriers from the training sessions in 2019 as compared to 2020 on assessing specialty support, concerns about diversion and misuse, lack of confidence and reimbursement were similar and did not differ statistically.

Significance: This study sheds additional light that clinicians working in rural health communities, may not readily engage in MAT due to perceived barriers with implementation. State and federal level solutions may be necessary to support clinicians who are vested in caring for patients with OUD through incentivization or access to resources to permit the integration of MAT into clinical practice settings.

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