Martha Whitfield, PhD is Assistant Professor in the Community Nursing Department at the University of Massachusetts Dartmouth, USA. She is a Clinician Affiliate with the University of Vermont Center on Rural Addiction and serves on the Boards of the International Nurses Society on Addictions and the International Journal of Addictions Nursing. As a nurse practitioner, her clinical practice has spanned rural primary care to an urban inpatient addiction treatment service. Her research examines the information environment surrounding substance use and treatment and implications for clinicians in community settings, with a focus on equity-deserving populations. She received the 2024 NIDA Young Investigator Travel Award.

Abstract

Understanding buprenorphine prescribing hesitancy among rural nurse practitioners: Potential barriers to equitable opioid use disorder treatment access

Aims: Despite evidence-based treatments for opioid use disorder, including buprenorphine, many primary care providers do not offer this therapy. This study examined how rural nurse practitioners conceptualised buprenorphine’s role in opioid use disorder treatment and explored the personal, social, and structural determinants of prescribing hesitancy.

Methods: Purposive and network sampling was used to recruit 17 rural primary care nurse practitioners not currently prescribing buprenorphine across three states in the Northeastern United States. Interviews were transcribed via Otter.ai and verified for accuracy. Data were analysed using Dedoose software and themes developed using reflexive thematic analysis. Informed consent was obtained electronically and verbally. Ethical approval was granted by the University of Massachusetts Dartmouth Institutional Review Board.

Results: Preliminary themes shaping nurse practitioner hesitancy around prescribing buprenorphine included: knowledge and confidence gaps; discomfort with patient communication and the perceived burden of opioid use disorder-related patient interactions; structural barriers including administrative burden and pharmacy access; and rural patient barriers such as transportation, stigma, and scarce behavioural health resources. Despite these barriers, nurse practitioners expressed openness to expanded prescribing with adequate education and mentorship.

Conclusions: Provider hesitancy remains a significant barrier to buprenorphine integration in primary care. These challenges are compounded in rural settings, where patients may face additional barriers including transportation limitations, geographic isolation, and socioeconomic disadvantage. Identifying the determinants of hesitancy is critical for developing targeted strategies to support nurse practitioner prescribers and ensuring opioid use disorder treatment is routinely accessible in primary care settings.