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Washington State expanded access to MOUD through its opioid treatment networks (OTN), which provide low\u2010barrier access to MOUD in non\u2010traditional settings with an emphasis on buprenorphine and rural locations. We examined changes in buprenorphine utilization between Medicaid beneficiaries who initiated treatment at OTNs compared to individuals outside OTN facilities and by rural\u2013urban residence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We used comparative time\u2010series analyses to examine longitudinal patterns of buprenorphine utilization among a sample (\n                      <jats:italic>n<\/jats:italic>\n                      = 93,401) of age 18 to 64 Washington State Medicaid beneficiaries diagnosed with OUD between 2019 and 2022. Monthly aggregated rates of buprenorphine utilization, stratified by OTN versus non\u2010OTN and rural\u2013urban residence, were calculated for analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      Between 2019 and 2022, rates of buprenorphine utilization were significantly higher among Medicaid beneficiaries initiating treatment at OTNs compared to beneficiaries treated at non\u2010OTN facilities regardless of rural\u2013urban status. Furthermore, utilization was most prevalent among rural OTNs (\u03b2 = 25.5, SE = 1.91,\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001, 95% CI 21.7, 29.2). Despite increases in OUD prevalence, buprenorphine rates remained consistent during the study period, except for a decrease within micropolitan OTNs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Washington's OTN provides an example of one strategy that may support greater prescribing of buprenorphine and help mitigate the opioid crisis in small town\/rural areas. Except among micropolitan areas, OTNs were able to keep pace in buprenorphine utilization despite demand from increased OUD prevalence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70139","type":"journal-article","created":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T09:01:05Z","timestamp":1774602065000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Expanding access to low\u2010barrier opioid use disorder treatment in non\u2010traditional settings: Washington's opioid treatment network"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0455-6762","authenticated-orcid":false,"given":"Shay M.","family":"Daily","sequence":"first","affiliation":[{"name":"Institute for Behavioral Health Heller School for Social Policy and Management Brandeis University  Waltham Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9234-5641","authenticated-orcid":false,"given":"Sharon","family":"Reif","sequence":"additional","affiliation":[{"name":"Institute for Behavioral Health Heller School for Social Policy and Management Brandeis University  Waltham Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Speaker","sequence":"additional","affiliation":[{"name":"Department of Research and Data Analysis Washington State Department of Social and Health Services  Olympia Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee","family":"Panas","sequence":"additional","affiliation":[{"name":"Institute for Behavioral Health Heller School for Social Policy and Management Brandeis University  Waltham Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grant T.","family":"Ritter","sequence":"additional","affiliation":[{"name":"Institute for Behavioral Health Heller School for Social Policy and Management Brandeis University  Waltham Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen T.","family":"Stewart","sequence":"additional","affiliation":[{"name":"Institute for Behavioral Health Heller School for Social Policy and Management Brandeis University  Waltham Massachusetts USA"},{"name":"Department of Health Law Policy and Management Boston University School of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,27]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.15620\/cdc\/170565"},{"key":"e_1_2_9_3_1","volume-title":"Provisional Drug Overdose Death Counts","author":"Ahmad F","year":"2023"},{"key":"e_1_2_9_4_1","volume-title":"Drug Overdose Deaths: Facts and Figures","author":"National Institute on Drug Abuse"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(11)60358\u20109"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD002207.pub4"},{"issue":"3","key":"e_1_2_9_7_1","article-title":"Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence","volume":"2009","author":"Mattick RP","year":"2009","journal-title":"Cochr Database Syst Rev"},{"key":"e_1_2_9_8_1","first-page":"25310","volume-title":"Medications for Opioid Use Disorder Save Lives","author":"National Academies of Sciences, Engineering, and Medicine","year":"2019"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.7326\/M17\u20103107"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000001689"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2016.10.015"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.7374"},{"key":"e_1_2_9_13_1","unstructured":"Substance Abuse and Mental Health Services Administration.Waiver Elimination (MAT Act). 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