title: Buprenorphine therapy for opioid addiction in rural Washington: the experience of the early adopters.
abstract: BACKGROUND
  The introduction of buprenorphine as office-based treatment for opioid dependence was designed to expand treatment capacity, but virtually there are no data about use of this medication in rural areas.
  
  
  METHODS
  The survey of the first cohort of physicians in rural Washington State who obtained buprenorphine waivers (2002-2010) to determine the volume of treated patients, physician appraisal of the efficacy of this treatment, and perceived barriers to treatment was conducted. Twenty-four (73 percent) of the 33 rural buprenorphine-certified physicians practicing in the state were interviewed in 2010.
  
  
  RESULTS
  Twenty physicians (83 percent) were actively prescribing buprenorphine/naloxone for treatment of addiction. Those currently prescribing averaged 23 active patients and had treated 125 patients since certification. All respondents reported that buprenorphine was efficacious in the treatment of addiction and 95 percent recommended that other rural colleagues adopt buprenorphine treatment. The following four major barriers were cited: 1) lack of adequate financial support from Medicaid, the largest source of third-party coverage for these patients; 2) unavailability of local mental health and behavioral addiction treatment services; 3) difficulty in finding consultants to assist in managing complex patients; and 4) shortages of other rural physicians providing this service.
  
  
  CONCLUSIONS
  Buprenorphine is viewed as a highly effective treatment of opioid addiction by early adopters in rural Washington State, but relatively few rural physicians currently provide this service. Inadequate insurance coverage, a shortage of effective links with consultants and colleagues, and the lack of mental health services are persistent barriers to the use of this modality in rural Washington State.
authors.affiliation: Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington, USA.
authors.forename: Tyler L
authors.initials: TL
authors.lastname: Quest
authors.forename: Joseph O
authors.initials: JO
authors.lastname: Merrill
authors.forename: John
authors.initials: J
authors.lastname: Roll
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Saxon
authors.forename: Roger A
authors.initials: RA
authors.lastname: Rosenblatt
mesh_terms: D002047:Buprenorphine / Q000627:therapeutic use*; D000069479:Buprenorphine, Naloxone Drug Combination; D019538:Health Care Surveys; D006801:Humans; D009270:Naloxone / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000534:rehabilitation; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D019035:Rural Health Services / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014861:Washington
chemical_list: D000069479:Buprenorphine, Naloxone Drug Combination; D009270:Naloxone; D002047:Buprenorphine