Developing a Tailored Stigma Reduction Intervention to Increase Buprenorphine Prescribing among Rural Primary Care Providers in Ohio

At Ohio University’s Heritage College of Osteopathic Medicine a new project in collaboration with the Appalachian Institute to Advance Health Equity Science (ADVANCE), and funded by the National Institute on Drug Abuse is working to develop and pilot a tailored stigma-reduction training intervention intended to increase buprenorphine prescribing among rural primary care providers in Ohio. Limited harm reduction services are more pronounced in Ohio’s rural counties than in urban counties, leaving rural patients with opioid use disorder with reduced access to evidence-based treatment. Buprenorphine, a medication used to treat opioid use disorder by managing withdrawal symptoms and reducing cravings, is underutilized in many rural settings because of stigma and hesitancy among prescribers. Buprenorphine lowers overdose risk and decreases transmission of infectious diseases such as HIV and hepatitis C when paired with access to treatment.

The study will measure attitudes of physicians, nurses and physician assistants toward prescribing buprenorphine, focusing on federally qualified health centers in rural Ohio that serve uninsured and underserved populations. Based on these assessments, the team will develop an approximately one-hour online training program designed to reduce stigma and increase prescriber comfort with buprenorphine. The training will include education on how buprenorphine works, perspectives from health care professionals who have successfully prescribed it, and practical content to address common concerns causing hesitation. After the initial training, medical professionals will complete a booster module and participate in an hour-long session with an addiction medicine professional and experienced prescribers to ask questions and discuss barriers to prescribing.

The project builds directly on earlier research that identified greater physician bias and fewer local harm reduction resources in rural areas, providing a clear rationale for a targeted intervention to shift clinician attitudes and behaviors in these communities. The research aims not only to increase the number of clinicians willing to prescribe buprenorphine but also to enhance equitable access to effective medication treatment for opioid use disorder across rural Ohio. By focusing on federally qualified health centers that serve populations facing the greatest access barriers, the intervention is tailored to settings where impact could be substantial. The study acknowledges that changing clinician behavior is challenging but argues that improved awareness and peer-informed clinical perspectives can shift practice patterns over time. If successful, the training could serve as a scalable model to reduce stigma, increase evidence-based prescribing, and ultimately improve treatment access and outcomes for people with opioid use disorder in underserved rural communities