{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T13:26:52Z","timestamp":1791725212572,"version":"4.3.4"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T00:00:00Z","timestamp":1643587200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T00:00:00Z","timestamp":1643587200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100008199","name":"RTI International","doi-asserted-by":"publisher","award":["Internal Funding"],"award-info":[{"award-number":["Internal Funding"]}],"id":[{"id":"10.13039\/100008199","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Addict Sci Clin Pract"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Medications to treat opioid use disorder (OUD) including buprenorphine products are evidence-based and cost-effective tools for combating the opioid crisis. However, limited availability to buprenorphine is pervasive in the United States (US) and may serve to exacerbate the deadly epidemic. Although prior research points to rural counties as especially needy of strategies that improve buprenorphine availability, it is important to investigate the availability of waivered providers according to treatment need as defined by the county-level rate of opioid-overdose deaths (OOD). This study examined differences in buprenorphine provider availability relative to treatment need among rural and urban counties in the US.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Buprenorphine provider availability relative to need in each county was defined as the number of waivered providers divided by the rate of OODs (i.e., number of OODs\/100,000 population), according to 2018 data. Counties with ratios in the bottom tertile of their state were classified as buprenorphine undersupplied. We estimated logit models to statistically test the association of rurality and state\u00a0main effects and their interaction terms (independent variables) and the county classified as buprenorphine undersupplied (dependent variable).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 38 states and 2595 counties had sufficient non-suppressed data to remain in the analysis. A larger percent of urban counties (36.43%) than rural counties (32.01%) were classified as buprenorphine undersupplied (p\u2009 =\u20090.001). The likelihood of a rural county being undersupplied varied considerably by state (Chi Square\u2009 =\u200982.88, p\u2009 =\u20090.000). All states with significant (p\u2009 &lt;\u20090.05 or p\u2009 &lt;\u20090.10) interaction terms showed lower likelihood of buprenorphine undersupply in rural counties.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The rural\u2013urban distribution in undersupply of waivered buprenorphine providers relative to need varied markedly by state. Strategies for improving access to buprenorphine-waivered providers should be state-centric and informed by county-specific indicators of need.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13722-021-00282-2","type":"journal-article","created":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T11:17:57Z","timestamp":1643627877000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Rural and urban differences in undersupply of buprenorphine provider availability in the United States, 2018"],"prefix":"10.1186","volume":"17","author":[{"given":"Kevin P.","family":"Conway","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9055-2022","authenticated-orcid":false,"given":"Dalia","family":"Khoury","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Hilscher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnie P.","family":"Aldridge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie J.","family":"Parker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary A.","family":"Zarkin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,1,31]]},"reference":[{"issue":"1","key":"282_CR1","doi-asserted-by":"publisher","first-page":"59","DOI":"10.7326\/M20-1210","volume":"173","author":"WC Becker","year":"2020","unstructured":"Becker WC, Fiellin DA. When epidemics collide: coronavirus disease 2019 (COVID-19) and the opioid crisis. Ann Intern Med. 2020;173(1):59\u201360. https:\/\/doi.org\/10.7326\/M20-1210.","journal-title":"Ann Intern Med"},{"issue":"5","key":"282_CR2","doi-asserted-by":"publisher","first-page":"e29298","DOI":"10.2196\/29298","volume":"7","author":"D Khoury","year":"2021","unstructured":"Khoury D, Preiss A, Geiger P, Anwar M, Conway K. Increases in naloxone administrations by Emergency Medical Services providers during the COVID-19 pandemic: retrospective time series study. JMIR Public Health Surveill. 2021;7(5):e29298. https:\/\/doi.org\/10.2196\/29298.","journal-title":"JMIR Public Health Surveill"},{"key":"282_CR3","unstructured":"Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple cause of death 1999\u20132018 on CDC WONDER online database. https:\/\/www.cdc.gov\/drugoverdose\/data\/statedeaths.html. Accessed 28 Jun 2020."},{"issue":"3","key":"282_CR4","doi-asserted-by":"publisher","first-page":"137","DOI":"10.7326\/M17-3107","volume":"169","author":"MR Larochelle","year":"2018","unstructured":"Larochelle MR, Bernson D, Land T, Stopka TJ, Wang N, Xuan Z, et al. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study. Ann Intern Med. 2018;169(3):137\u201345. https:\/\/doi.org\/10.7326\/M17-3107.","journal-title":"Ann Intern Med"},{"issue":"2","key":"282_CR5","doi-asserted-by":"publisher","first-page":"90","DOI":"10.7326\/M18-0227","volume":"170","author":"SM Murphy","year":"2019","unstructured":"Murphy SM, McCollister KE, Leff JA, Yang X, Jeng PJ, Lee JD, et al. Cost-effectiveness of buprenorphine-naloxone versus extended-release naltrexone to prevent opioid relapse. Ann Intern Med. 2019;170(2):90\u20138. https:\/\/doi.org\/10.7326\/M18-0227.","journal-title":"Ann Intern Med"},{"key":"282_CR6","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j1550","volume":"357","author":"L Sordo","year":"2017","unstructured":"Sordo L, Barrio G, Bravo MJ, Indave BI, Degenhardt L, Wiessing L, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 2017;357: j1550. https:\/\/doi.org\/10.1136\/bmj.j1550.","journal-title":"BMJ"},{"issue":"2","key":"282_CR7","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1001\/jamapsychiatry.2018.3126","volume":"76","author":"ND Volkow","year":"2019","unstructured":"Volkow ND, Jones EB, Einstein EB, Wargo EM. Prevention and treatment of opioid misuse and addiction: a review. JAMA Psychiat. 2019;76(2):208\u201316. https:\/\/doi.org\/10.1001\/jamapsychiatry.2018.3126.","journal-title":"JAMA Psychiat"},{"issue":"1","key":"282_CR8","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1370\/afm.1735","volume":"13","author":"RA Rosenblatt","year":"2015","unstructured":"Rosenblatt RA, Andrilla CHA, Catlin M, Larson EH. Geographic and specialty distribution of US physicians trained to treat opioid use disorder. Ann Fam Med. 2015;13(1):23\u20136. https:\/\/doi.org\/10.1370\/afm.1735.","journal-title":"Ann Fam Med"},{"issue":"1","key":"282_CR9","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1111\/jrh.12307","volume":"35","author":"CHA Andrilla","year":"2019","unstructured":"Andrilla CHA, Moore TE, Patterson DG, Larson EH. Geographic distribution of providers with a DEA waiver to prescribe buprenorphine for the treatment of opioid use disorder: a 5-year update: distribution of providers with a DEA waiver. J Rural Health. 2019;35(1):108\u201312. https:\/\/doi.org\/10.1111\/jrh.12307.","journal-title":"J Rural Health"},{"issue":"6","key":"282_CR10","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.1377\/hlthaff.2014.1205","volume":"34","author":"AW Dick","year":"2015","unstructured":"Dick AW, Pacula RL, Gordon AJ, Sorbero M, Burns RM, Leslie D, et al. Growth in buprenorphine waivers for physicians increased potential access to opioid agonist treatment, 2002\u201311. Health Aff. 2015;34(6):1028\u201334. https:\/\/doi.org\/10.1377\/hlthaff.2014.1205.","journal-title":"Health Aff"},{"issue":"7","key":"282_CR11","doi-asserted-by":"publisher","first-page":"504","DOI":"10.7326\/M19-2403","volume":"172","author":"RK McBain","year":"2020","unstructured":"McBain RK, Dick A, Sorbero M, Stein BD. Growth and distribution of buprenorphine-waivered providers in the United States, 2007\u20132017. Ann Intern Med. 2020;172(7):504\u20136. https:\/\/doi.org\/10.7326\/M19-2403.","journal-title":"Ann Intern Med"},{"issue":"6","key":"282_CR12","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2019.6373","volume":"2","author":"RL Haffajee","year":"2019","unstructured":"Haffajee RL, Lin LA, Bohnert ASB, Goldstick JE. Characteristics of US counties with high opioid overdose mortality and low capacity to deliver medications for opioid use disorder. JAMA Netw Open. 2019;2(6): e196373. https:\/\/doi.org\/10.1001\/jamanetworkopen.2019.6373.","journal-title":"JAMA Netw Open"},{"issue":"8","key":"282_CR13","doi-asserted-by":"publisher","first-page":"e2014045","DOI":"10.1001\/jamanetworkopen.2020.14045","volume":"3","author":"A Duncan","year":"2020","unstructured":"Duncan A, Anderman J, Deseran T, Reynolds I, Stein BD. Monthly patient volumes of buprenorphine-waivered clinicians in the US. JAMA Netw Open. 2020;3(8):e2014045.","journal-title":"JAMA Netw Open"},{"key":"282_CR14","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.10542","author":"BD Stein","year":"2016","unstructured":"Stein BD, Sorbero M, Dick AW, Liccardo-Pacula R, Burns RM, Gordon AJ. Physician capacity to treat opioid use disorder with buprenorphine-assisted treatment. JAMA. 2016. https:\/\/doi.org\/10.1001\/jama.2016.10542.","journal-title":"JAMA"},{"key":"282_CR15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2017.04.005","author":"AS Huhn","year":"2017","unstructured":"Huhn AS, Dunn KE. Why aren\u2019t physicians prescribing more buprenorphine? J Subst Abuse Treat. 2017. https:\/\/doi.org\/10.1016\/j.jsat.2017.04.005.","journal-title":"J Subst Abuse Treat"}],"container-title":["Addiction Science &amp; Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13722-021-00282-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13722-021-00282-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13722-021-00282-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,31]],"date-time":"2022-01-31T11:33:06Z","timestamp":1643628786000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascpjournal.biomedcentral.com\/articles\/10.1186\/s13722-021-00282-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,31]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["282"],"URL":"https:\/\/doi.org\/10.1186\/s13722-021-00282-2","relation":{},"ISSN":["1940-0640"],"issn-type":[{"value":"1940-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,31]]},"assertion":[{"value":"28 December 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 December 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 January 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study consisted of secondary analyses; no individuals were involved. As data do not include any personally identifiable information, Institutional Review Board approval was not required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Authors report no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"5"}}