This study uses healthcare claims data to (1) describe the workforce that is caring for rural (including large rural, small rural, and isolated small rural) versus urban populations with opioid use disorder (OUD), treatments received, (including medication and cognitive therapy), and retention in treatment (duration); (2) explore regional differences in care for urban and rural patients; (3) compare the care received by patients living in counties with and without Drug Enforcement Agency (DEA)-waivered providers; (4) compare the distance and time that patients from large, small, and isolated small rural places travel for OUD care compared to urban patients; and (5) compare the cost of treatment for patients with OUD from rural and urban areas. Analyses will also compare nurse practitioner (NP) prescribing practices in states that require NP supervision by physicians with those that allow NPs to prescribe autonomously.

Findings from this study can be used to improve national and state policies regarding the DEA waiver to prescribe buprenorphine and scope of practice, which could improve access for rural and other disadvantaged populations. Our analysis will also provide helpful insights about where and from whom rural patients with OUD receive care (such as psychosocial support) in the absence of a comprehensive OUD treatment workforce in their local communities.