I Prescribe Suboxone in Primary Care: Empowering Rural Recovery in 2025

There were 283 drug overdose deaths in Maryland during the first quarter of 2025. 2 days ago, there was another overdose at the local WaWa.

I am priviledge to treat opiate addiction in my community in QAC Maryland. The toll that addition takes on our small community, like all communities, is heart breaking. I still remember watching Panic in Needle Park back in the '70s—a raw, haunting look at heroin addicts scraping by on the streets of New York City. My parents brushed it off, saying it was just about "junkies" in the big city, nothing that could touch us out here in rural Maryland. At the time, I thought it was odd my parents weren't more concerned about people in the city. Little did they know, decades later, addiction would hit so close to home: my own sons—one struggling with alcohol, the other with heroin and, and now- fentanyl.

Growing up in an alcoholic household myself, I knew the chaos, the fear, the secrets we kept to "protect" the family. It shaped me, drove me into nursing, and eventually into this fight against opioid use disorder (OUD). What started as a city problem has seeped into every corner of rural America, including our quiet Eastern Shore communities.

In the 1970s, overdose panic was confined to urban shadows. Today, it's in our backyards and our neighbors' homes. Just months after my son entered rehab in 2015, a family up the street lost their daughter to an overdose—she was found with a needle in her arm. Stories like that aren't rare anymore; they're the reality for too many families in rural areas, where resources are scarce and stigma runs deep.

While cities often have dedicated treatment centers, rural areas like ours are left with gaps—long waits, travel barriers, and limited options. That's why primary care providers are stepping up, encouraged to integrate medication-assisted treatment (MAT) like Suboxone (buprenorphine/naloxone) right into everyday practice. It curbs cravings, stabilizes lives, and prevents overdoses, all while addressing the whole person: their blood pressure, their mental health, their chronic conditions.

For the past seven years, I've been prescribing Suboxone as part of my primary care work on the Eastern Shore. Now, as owner and operator of Nurse RX—an NHSC-approved SUD treatment site—I'm dual-certified as a Family and Psychiatric Mental Health Nurse Practitioner, serving adults from 18 to geriatric. I provide timely MAT alongside integrated psychiatric care, and primary care for both acute and chronic issues, with support services tailored to those battling addiction. It's challenging—navigating regulations, coordinating with coalitions like Queen Anne's County Drug Free Coalition.

I've seen lives rebuilt: parents reuniting with kids, folks holding down jobs, communities healing one person at a time. Most of my patients are everyday people—hard-working men and women grateful for a provider who can handle their Suboxone alongside their lisinopril or therapy sessions. They're not criminals; they're sick, often carrying the weight of trauma like I did growing up. And with tools like telepsychiatry, which has been well reserached, we can reach even the most isolated rural spots.

If you're a primary care clinician in a rural area, I urge you to join this effort. We can't fix everything—I've learned that the hard way, from trying to "save" my family as a kid to realizing only God and evidence-based care can truly heal—but we can make a difference. Together, let's bring hope and recovery to our underserved communities.

References

American Academy of Family Physicians. (2023). Management of chronic pain and opioid misuse: A position paper from the AAFP (updated). American Family Physician, 107(4), 345–347. https://www.aafp.org/pubs/afp/issues/2023/0400/chronic-pain-opioid-misuse.html

Andrilla, C. H. A., Patterson, D. G., & Garberson, L. A. (2024). Expanding buprenorphine prescribing in rural primary care: Barriers and facilitators. Journal of Rural Health, 40(1), 112-120. https://doi.org/10.1111/jrh.12789

Centers for Disease Control and Prevention. (2025). Provisional drug overdose death counts. National Center for Health Statistics. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

Rigg, K. K., & Monnat, S. M. (2023). Rural-urban differences in opioid overdose mortality: Trends and implications for intervention. International Journal of Drug Policy, 112, 103950. https://doi.org/10.1016/j.drugpo.2023.103950

Velez, B. H. (2021). Development and evaluation of a nurse-practitioner-directed telepsychiatry program for opiate use disorder patients in a rural primary care practice. Wilmington University. https://www.proquest.com/openview/28021317461628bb14e03e98eb58992d/1?pq-origsite=gscholar&cbl=18750&diss=y