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Cutler report provides insight into opioid use and barriers to treatment access in rural Maine

Rural practitioners and community stakeholders say opioid use disorder (OUD) has increased during the COVID-19 pandemic, but access to treatment with medications for OUD (MOUD; e.g., buprenorphine, methadone) has not. Rural Maine continues to grapple with barriers to OUD treatment, and a new report provides much-needed insight into the problem.

The Maine Baseline Needs Assessment: Rural Practitioners and Stakeholders Report presents results from a statewide needs assessment of healthcare practitioners and community stakeholders working in rural Maine, conducted by the University of Vermont Center on Rural Addiction (UVM CORA) and the Catherine Cutler Institute’s (CCI) Substance Use Research & Evaluation (SURE) Unit at the University of Southern Maine (USM). 

Designed to identify substance use disorder treatment needs and barriers, the Maine baseline needs assessment received responses from 174 healthcare practitioners and 141 community stakeholders working in rural areas throughout the state. 

Needs assessment respondents reported that the primary barriers to patients accessing OUD treatment are lack of time, transportation, housing, and other supports. One practitioner who currently treats patients with MOUD remarked that, “transportation is a huge issue; we have no reliable public transport.” 

Most practitioners agreed that MOUD are the most effective way to treat people with OUD. However, only half of practitioners and just one-in-five stakeholders reported that people in their communities have adequate access to effective substance use treatment. One practitioner who is not currently treating patients with MOUD noted that “more providers, including nurse practitioners, [are needed] to be able to prescribe these medications for OUD.” Additionally, a community stakeholder noted that “waitlists are long, and we lose many people during the short window after they decide to enter recovery.” 

Rural practitioners identified time and staffing constraints as well as concerns about medication diversion as their top barriers to treating and retaining patients with OUD. One practitioner who currently treats patients with MOUD noted that “more providers [are] needed to expand capacity to take on more patients,” and that “more support staff [are needed].” A community stakeholder shared that we need to “get boots on the ground and do outreach to the areas we know are hardest hit,” as well as to “address stigma.” While rural Maine practitioners reported moderate to high comfort treating patients with OUD, they are less comfortable treating special populations such as adolescents and providing family-based interventions.

Lindsey Smith, Ph.D., Director of the SURE Unit at USM CCI and a lead partner on the project, said, “we're excited to use the results of the CORA needs assessment to inform policies aimed at enhancing statewide capacity to address the needs of those with substance use disorders, with the goal of improving access to substance use treatment services in rural Maine.”



UVM CORA’s mission is to expand substance use treatment capacity in rural areas by providing consultation, resources, training, and evidence-based technical assistance to healthcare providers and community organizations. USM CCI helps organizations and communities thrive by translating knowledge and best practices into sustainable practical solutions to critical societal issues. 

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $13,699,254 with zero percentage financed with non-governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.