provider prescribing and capacity , and 71 % of study respondents stated they would provide MAT service programs if guidelines were issued by a professional society . To note , both the American Society of Addiction Medicine ( ASAM ) and the Substance Abuse and Mental Health Services Administration ( SAMSHA ) have issued comprehensive guidance ; 13 however , treatment providers may not feel these agency guidelines apply to them in the current care model they may be operating .
This study did not find any one consensus on the specialty type that should be primarily responsible for MAT prescribing . However , focusing efforts on increased addiction medicine training of primary care physicians ( family medicine , internal medicine , pediatrics , and obstetric / gynecologists ), may be both feasible and logical as many are rural and isolated from specialty and alternative care options . There was no significant difference in the responses of willingness to expand practice in MAT between primary and specialty care prescribers . With only 68-75 % of trained prescribers utilizing MAT training , amid a decreasing number of patients per MAT provider and an increasing overdose mortality rate , a broad statewide approach to provider training in MAT may not be the most effective . A more efficient , longterm solution may be a targeted approach to provider shortage sites and areas , while formally training and supporting PCPs with a vested interest in treating patients with SUD and increasing the number of addiction medicine fellowship positions . Expanding addiction medicine fellowship opportunities and offering telehealth support for providers could further serve as a valuable recruitment and retention tool for MAT provision in critical areas of need .
CONCLUSION
Data collected from WV providers highlight the most significant barriers directly affecting practice , interest , and satisfaction in providing MAT . MAT providers widely report receiving support from their institutions , fellow physicians , and staff . Moreover , comments in support of MAT suggested providing more support services for patients before , during , and after MAT treatment . While many providers focus on the significant obstacles of treating OUD , those who currently provide MAT report comfort and competence as part of an integrated care model wherein responsibilities are shared across the continuum of care . Expansion of coverage by insurance carriers for effective or at least cost neutral alternative pain treatments should be encouraged . As successfully demonstrated in select areas , a significant shift may be in order to cultivate quality , evidence-based integrated care and service models that encompass family and primary care with specialist , referral , and wraparound support to cultivate more efficient treatment processes and long-term recovery success . This study offers a baseline for examining the attitudes , beliefs , and experiences of active WV providers on the MAT practice environment . Notably , WV has expanded the number of waivered and active providers who feel comfortable and competent in MAT provision . Nevertheless , this research suggests further investigation is needed into the disparities in MAT distribution and volume and the perceptions of unwilling providers , particularly those rural primary care practitioners who may be key to access to care . Lastly , future legislative and policy initiatives in WV should be informed by the provider community to avoid creating unforeseen barriers to participation and expansion of care . Further research should examine MAT expansion across WV over the next five years , as well as efforts to educate and support providers and mitigate barriers to MAT provision .
Several limitations to the current study exist . The study population included all providers eligible to prescribe for acute and chronic pain and MAT . Among study respondents , there is a low representation of providers who prescribe MAT . The surveys were distributed widely to prescribers of scheduled medication through statewide organizations . A more targeted distribution could have provided better accuracy . There were also too many respondent prescribers who do not have MAT as a therapeutic option . While the results of this study followed expected results based on qualitative data collected from the content experts during survey design , the low response rate could skew the percentage of providers that might respond to specific questions across the full population .
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