Facilitation Program Increased Medication for Opioid Use Disorder Prescribing in Rural Primary Care Clinics

Medications for opioid use disorder (MOUD) are critically under-prescribed, especially in primary care settings. Researchers assessed the Integrated Support for MOUD (ISMOUD)* program, a primary care-based intervention implemented in 15 independent rural practices in Colorado that served Medicaid patients and prescribed MOUD to fewer than 10 patients at baseline. The study compared the number of active buprenorphine prescriptions and implementation ratings of ISMOUD milestones before and after program implementation.

• Practices were largely family medicine-only (73 percent) with one or two clinicians (73 percent).
• ISMOUD facilitators most commonly interacted with practices via email (mean 22 interactions per practice out of 33 total interactions per practice).
• The mean number of active buprenorphine prescriptions increased from 2.1 unique patients in the three months prior to program implementation to 11.3 at 13 months post-implementation.
• Rates of implementation of ISMOUD milestones increased significantly over the study period (23–40 percent of milestones implemented at baseline versus 84–93 percent by program end).

* ISMOUD consisted of a standardized MOUD curriculum, access to addiction medicine consultants (remotely and in person), monthly meetings with trained facilitators, and financial incentives.

Comments: This study described an implementation model for improving MOUD uptake targeting a particularly vulnerable group: rural, low-income populations with very limited prior access to MOUD. The model takes advantage of available resources (primary care physicians), and provides access to remote addiction treatment specialists. Though the increase in prescribing was relatively modest, even with substantial financial incentives, this study suggests that education and support can lead to increases in MOUD prescribing in underserved populations.

Elliott Brady, MD, MPH* & Darius A. Rastegar, MD

* 2024–2025 Rich Saitz Editorial Intern & Addiction Medicine Fellow, Montefiore Einstein Addiction Medicine Fellowship Program

Reference: Hall TL, Mendez D, Sobczak C et al. Evaluation of a program designed to support implementation of prescribing medication for treatment of opioid use disorder in primary care practices. Ann Fam Med. 2025;23(1):44–51.