University of Kentucky, College of Social Work, 619 Patterson Office Tower, Lexington, KY 40506-0027, USA.
Utah State University, Department of Social Work, 0730 Old Main Hill, Logan, UT 84322-0730, USA.
J Subst Use Addict Treat. 2023 Dec;155:209153. doi: 10.1016/j.josat.2023.209153. Epub 2023 Sep 9.
The United States has experienced substantial increases in opioid use for more than two decades. This growth has impacted rural areas where overdoses have risen drastically during this time period and more often involve prescription opioids than in urban areas. Medications for opioid use disorders (MOUDs) are highly underutilized in rural settings due to lack of access, inadequate prescribing, and stigma.
The study collected data using a cross-sectional online survey of nonprescribing clinicians (NPCs) involved in the treatment of substance use disorders (SUDs) in the United States. The study used multiple recruitment methods to obtain a purposive sample of NPCs from a variety of geographical contexts across the nation. The survey assessed demographic and practice characteristics including rurality of practice location, exposure and training related to MOUDs, treatment orientation, treatment preferences for opioid use disorder (OUD), and attitudes toward MOUDs. The study compared treatment preferences for OUD and attitudes toward MOUDs based on rurality of practice location. We tested a mediation model to determine whether the relationship between rurality of practice setting and attitudes toward MOUDs is mediated by treatment orientation.
Most of the 636 NPCs surveyed favored a combination of MOUDs and psychosocial treatment. Compared to clinicians practicing in suburban or urban areas, self-identified rural clinicians were more likely to favor MOUDs alone as most effective and less likely to endorse a combination of MOUDs and psychosocial treatment. Although most NPCs were supportive of MOUDs overall, many endorsed misconceptions related to MOUDs. Rural clinicians were less likely to perceive MOUDs as effective or acceptable compared to those in urban settings. Results of a mediation analysis indicated that practicing in a rural location compared to in an urban location directly and indirectly influenced attitudes toward MOUDs through an effect on treatment orientation.
NPCs play important roles in the implementation of MOUDs, and while efforts to increase their knowledge of and exposure to MOUDs have contributed broadly to more favorable attitudes toward MOUDs among NPCs, this study's findings indicate that additional efforts are still needed, particularly among NPCs who work in rural settings. Findings also indicate that, among rural clinicians, increasing knowledge of and exposure to harm reduction principles may be a necessary prerequisite to engaging them in the implementation of specific harm reduction strategies such as MOUDs.
美国的阿片类药物使用量在过去二十多年里大幅增加。这种增长影响了农村地区，在此期间，农村地区的过量用药急剧上升，而且与城市地区相比，更多涉及处方阿片类药物。由于获取途径有限、处方不当和污名化，农村地区对治疗阿片类药物使用障碍（MOUD）的药物的使用严重不足。
该研究通过对参与美国物质使用障碍（SUD）治疗的非处方临床医生（NPC）进行横断面在线调查收集数据。该研究采用多种招募方法，从全国不同地理背景下获得了各种 NPC 的目标样本。该调查评估了人口统计学和实践特征，包括实践地点的农村性、与 MOUD 相关的暴露和培训、治疗方向、对阿片类药物使用障碍（OUD）的治疗偏好，以及对 MOUD 的态度。该研究根据实践地点的农村性比较了对 OUD 的治疗偏好和对 MOUD 的态度。我们测试了一个中介模型，以确定实践环境的农村性与对 MOUD 的态度之间的关系是否通过治疗方向来中介。
在接受调查的 636 名 NPC 中，大多数人赞成将 MOUD 与心理社会治疗相结合。与在郊区或城市地区执业的临床医生相比，自我认定的农村临床医生更倾向于单独使用 MOUD 作为最有效的方法，而不太倾向于将 MOUD 与心理社会治疗相结合。尽管大多数 NPC 总体上支持 MOUD，但许多人对 MOUD 存在误解。与城市环境相比，农村临床医生不太认为 MOUD 有效或可接受。中介分析的结果表明，与在城市环境中相比，在农村环境中执业直接和间接地通过对治疗方向的影响来影响对 MOUD 的态度。
NPC 在实施 MOUD 方面发挥着重要作用，尽管增加他们对 MOUD 的了解和接触的努力广泛促进了 NPC 对 MOUD 的更有利态度，但本研究的结果表明，仍需要进一步努力，特别是在农村环境中工作的 NPC。研究结果还表明，在农村临床医生中，增加对减少伤害原则的了解和接触可能是使他们参与实施特定减少伤害策略（如 MOUD）的必要前提。
