Project Summary
The United States is facing an opioid epidemic. Yet, disparities exist in the availability of effective treatments: only 49 percent of people with opioid addiction have access to doctors who can prescribe buprenorphine, with over 80 percent of rural areas having no prescribing doctors at all; methadone clinics and in-patient treatment programs are generally not available in rural areas. This availability shortage necessitates a new approach: expanding addiction treatment through the already-established infrastructure of primary care. We will train rural primary care clinicians to provide office-based opioid treatment (OBOT) using one of two evidence-based options: naltrexone (opioid receptor antagonist), buprenorphine (opioid receptor partial agonist), or both. Our primary outcome will be the number of trained clinicians who are providing OBOT at six, 12, 18, and 24 months post-training. Secondary outcomes include the number of patients who the trained clinician starts on OBOT, retains on OBOT, obtains urinalysis consistent with abstinence, and judges to be in recovery at 6, 12, 18, and 24 months post-treatment initiation. The long-term goal is to determine which primary care training regimen produces the greatest increase in capacity to meet patient needs for opioid addiction treatment in rural communities.