Research from JAMA Psychiatry — Topiramate for the Treatment of Cocaine Addiction — A Randomized Clinical Trial

Rural regions of the US have been disproportionately affected by the misuse of prescription and illicit opioids, with increased annual rates of per capita overdose deaths since 1999.^1,2 Opioid agonist medications (medications for opioid use disorder [MOUD]) approved for the treatment of opioid use disorder (OUD) include methadone and buprenorphine, both of which have demonstrated efficacy in decreasing opioid use and risk of overdose and death.^3,4 However, treatment programs are in short supply in rural areas⁵; more than 50% of rural US counties are without a single buprenorphine-waivered practitioner.^6-8 Moreover, it is estimated that 10% of the US population resides more than 10 miles (16 km) from the nearest buprenorphine practitioner, with 2.65 million individuals located more than 30 miles (48 km) away.⁹ This dearth of resources has rendered these communities poorly equipped to meet the increasing demand for MOUD.