Faculty Presentations Faculty Presentations: Martha M. Whitfield

Determinants affecting nurse practitioner treatment of opioid use disorder in primary care settings

Full list of poster authors

• Martha M. Whitfield, PhD, APRN
• Danielle Macdonald, PhD, RN
• Tracy Klein, PhD, ARNP
• Mike Mimirinis, PhD
• Rosemary Wilson, PhD RN(EC)

Conference where poster was previously displayed

Society for the Study of Addiction Annual Conference, 2025, Newcastle, UK

Poster abstract

Background/aims

Opioid use disorder (OUD) continues to result in significant mortality in North America. Despite regulatory changes increasing availability of medication for opioid use disorder (MOUD), most individuals with OUD do not receive treatment. Nurse practitioners (NPs) are an expanding workforce with the potential to significantly impact treatment by prescribing MOUD in primary care. This study aims to describe the determinants of NP treatment of OUD in North American primary care settings, including MOUD and prescribed alternatives (PA) and compare determinants based on geographic location (Canada vs. U.S.) and prescribing approach.

Methods

This secondary analysis of qualitative phenomenographic interview data used the Consolidated Framework for Implementation Research (CFIR) to explore barriers and facilitators to NP-provided MOUD/PA. The original study purposively sampled NPs working in primary care. Initial interviews focused on how NPs developed the capability to treat OUD. The current analysis examined barriers and facilitators to providing MOUD/PA, guided by CFIR’s Inner Setting (organizational culture, readiness, leadership, provider values), Outer setting (policy, patient needs, stigma), Innovation, Implementation, and Individuals domains. Dedoose software was used for coding, findings were synthesized using thematic analysis, and exemplar quotes extracted. Ethical approval was received from the Queen’s University Health Sciences and Affiliated Teaching Hospitals Research Ethics Review Board. 

Results

Interviews were completed with 21 NPs: 9 from New England (U.S.) and 12 from Ontario (Canada). Preliminary findings for barriers and facilitators included three cross-cutting themes:

1. Influence of Outer and Inner Setting culture and context on MOUD/PA implementation;
2. Knowledge sharing and information access across relational networks; and
3. Prioritization of client-centered care approaches focused on adaptable, risk-informed practice.

Conclusion

Despite effective OUD treatments, gaps in prescriber uptake persist. Findings from this study may inform future interventions to increase NP MOUD/PA prescribing.