Barriers to MOUD in Rural Areas
While some rural communities have built extensive capacity to treat opioid use disorder (OUD) in
response to the opioid crisis, some face
barriers to accessing OUD treatment. Barriers include a lack of treatment facilities that offer
medication for opioid use disorder (MOUD) or other treatment options, requiring patients to travel
farther to access care. According to the Pew Charitable Trusts,
almost 90% of rural communities lack the number of opioid treatment programs needed to meet
demand, and approximately 30% of rural Americans live in counties without any buprenorphine
providers. For comparison, only 2% of urban Americans live in counties without any buprenorphine
Many rural patients with OUD will have to travel outside their
community to access MOUD due to the limited treatment options available in most rural
communities. Many rural residents seeking MOUD face transportation barriers, including lack of a
driver's license, lack of access to a car, and lack of public transportation in the community.
Additionally, transportation time and costs have been shown to be barriers to care. Patients may need
to rely on friends or family to take them to appointments if they do not have a license or other
means of transportation. These transportation barriers can jeopardize follow-up visits and adherence
to treatment. To reduce this burden, providers can consider prescribing medication that can be
administered unsupervised at home and can consider telehealth options to prescribe medication,
communicate with patients, and counsel patients virtually.
Provider Knowledge, Attitudes, and Beliefs
In many rural communities, primary care providers serve large geographic areas and double as mental
health and substance use disorder treatment providers to address a shortage of specialty care. Yet,
very few rural primary care providers have obtained waivers to prescribe medication for the
treatment of OUD. A provider's willingness to become waivered and provide MOUD may be influenced by
other unique rural barriers, including:
Financial and reimbursement concerns
Resistance from practice partner(s)
Limited availability of specialty care providers
Lack of mental and behavioral health support services
Lack of confidence in clinical skills to manage OUD
Perceived lack of need for MOUD services
Many providers express a lack of confidence in their knowledge of substance use disorders and their
ability to treat patients with OUD. Very few medical schools require coursework or competencies
treating substance use disorders. Even with a basic understanding of substance use treatment,
providers may not have the expertise needed to treat more complex patients. To overcome this barrier,
providers may refer patients to local opioid treatment programs, where available, or use telehealth
to connect patients with specialists or other MOUD supports.
Once a provider has a waiver to prescribe buprenorphine for the treatment of OUD, there are
on the licensed provider's ability to prescribe medication. The regulations have changed over
time and provide a limit on the number of patients a single provider can treat with MOUD at any one
time. After the first year, a licensed provider can become eligible to increase the patient limit.
More information on waivers and prescribing limits is included in Module 4.
Stigma can be a significant barrier to seeking treatment for OUD. Patients may decide not to seek
treatment out of fear of losing their job or jeopardizing relationships with friends and family.
Providers and local organizations can be important advocates for reducing stigma by discussing
substance use disorders as chronic brain diseases, sharing the evidence that supports using
medication for treatment, and building awareness, knowledge, and support for MOUD programs in their
local communities. Additional information and program considerations for addressing stigma is
available in Module
Technology can improve access and quality of MOUD programs, and it can also present unique challenges
for rural communities. Both patients and providers may lack the technology infrastructure needed to
use health information technology (HIT) systems or telehealth, such as limited internet access and
availability of devices like laptops or cell phones. Adopting new technologies requires significant
financial investment that can be a barrier for many rural patients and practices. For more
information, see the Rural Telehealth Toolkit.
Resources to Learn More
for Opioid Use Disorder Improve Patient Outcomes
Provides an overview of opioid use disorder (OUD) and discusses FDA-approved medications for treating
OUD and their effectiveness. Emphasizes the importance of psychosocial treatment and discusses
barriers to accessing treatment.
Organization(s): The Pew Charitable Trusts