Rural Buprenorphine Prescribing Support Increased PCP Willingness to Treat OUD
Key Highlights
• The trial included 63 primary care clinicians across 27 Ohio community health centers.
• The buprenorphine prescribing support program was rated feasible, acceptable, and appropriate.
• Willingness to treat opioid use disorder and intention to prescribe buprenorphine increased after the intervention.
• The authors said a larger trial is needed to confirm preliminary findings.
A brief buprenorphine prescribing support program (BPSP) tailored for rural primary care was feasible, acceptable, and associated with increased willingness to treat opioid use disorder (OUD), according to findings from a cluster randomized clinical trial published in JAMA Network Open. The study evaluated whether a short online prescribing-support intervention could address clinical training gaps, misinformation, and stigma among rural primary care professionals.
Researchers conducted a pilot cluster randomized clinical trial involving 27 Ohio community health centers and 63 primary care clinicians, including 10 physicians, 50 nurse practitioners, and 3 physician assistants. Health centers were randomized 2:1 to receive either the BPSP or electronic copies of the American Society of Addiction Medicine buprenorphine prescribing guidelines. Data were collected from July 25, 2024, to February 28, 2025.
The intervention consisted of a 1-hour asynchronous online training program followed by an optional live virtual booster session. The training covered OUD screening and diagnosis, buprenorphine induction and maintenance, common myths about buprenorphine, stigma reduction, and patient and prescriber narratives. The program also included a buprenorphine start-up guide for prescribers.
Study Findings
Among the 63 clinicians, 48 were assigned to the intervention and 15 to the control condition. Most participants practiced in rural areas (78%), and only 16% had ever prescribed buprenorphine. Participants who received the prescribing support program rated it highly feasible, acceptable, and appropriate, with median scores of 4.25, 4.88, and 5.00, respectively, on 5-point measures.
Willingness to treat OUD increased significantly after the intervention; 86% of rank comparisons improved after training. Intention to prescribe buprenorphine in the next 6 months also increased significantly, with 98% of rank comparisons improving after the intervention. The study also found improvements in correct information about buprenorphine, confidence in treating substance use disorders, confidence in prescribing buprenorphine, stigma, and empathy toward patients with OUD.
Clinical Implications
According to the study authors, the findings suggest that tailored prescribing support for buprenorphine in primary care may be a promising strategy to expand access to buprenorphine in rural areas. They noted that the program was designed for rural primary care settings, where implementation barriers are distinct and access to buprenorphine remains limited.
The authors also identified limitations. The pilot study had a small sample size, and analyses did not adjust standard errors for clustering by clinic. The authors stated that a longer follow-up is needed to determine whether increased prescribing intention translates into prescribing behavior.
Expert Commentary
“Our pilot trial findings suggest that the BPSP is feasible, acceptable, and appropriate for rural primary care and may improve attitudes toward buprenorphine and willingness to prescribe. If it improves prescribing behavior in a larger trial, the BPSP has the potential to improve buprenorphine access in critically important rural areas,” the researchers concluded.
Reference
Franz B, Dhanani LY, Brook D, et al. Brief prescribing support and buprenorphine adoption in rural primary care: a cluster randomized clinical trial. JAMA Netw Open. 2026;9(3):e263050. doi:10.1001/jamanetworkopen.2026.3050