Comparing Buprenorphine-Prescribing Physicians Across Nonmetropolitan and Metropolitan Areas in the United States

This is an important study that addresses the continued high need for treatment options for Opioid Use Disorders in the rural United States. The role of the Primary Care Provider in this treatment is incredibly important and is of specific relevance to rural areas where psychiatric and behavioral health care may be limited, if available at all.

As Family Medicine physicians and educators, we must think about offering patients treatment options that best match their goals, and educate students and residents on the importance of learning these skills. Moving away from an abstinence only model is important for those patients who would benefit from medications such as buprenorphine to assist in their recovery, particularly if administered by a compassionate Family Physician who can competently discuss coping skills and remain open with patients to be honest with the struggles and potential relapses that occur in recovery. I would be curious to know if the higher dose prescribers utilize more of this harm reduction approach than those concerned about "illicit buprenorphine" by focusing on the decreased demand for the more deadly opioids.

It is reassuring to see that more providers are accepting a range of insurance, including Medicaid, and covering broad geographic regions. It is interesting to note proportionally fewer women prescribing buprenorphine in this study, and makes me want to learn more about the factors that led to physicians obtaining their buprenorphine waiver. As a rural Family Medicine Physician in the Pacific Northwest, I am proud that our region has a relatively higher proportion of prescribers in nonmetropolitan areas than other regions. I am, however, surprised by the high rate of in-office inductions in nonmetropolitan areas as I am concerned about the struggle of rural folks travelling while feeling ill from withdrawal and question if in-home inductions may continue to grow in popularity.

I hope this literature helps lend support to the consistent need for substance use treatment in the United States, particularly focused on supportive environments that can address co-existing physical and mental health needs to provide the integrated care that we as Family Physicians hope to provide to all of our patients.

Competing interests: None declared