["The Journal of Rural Health, Volume 42, Issue 2, Spring 2026. ", "\nAbstract\n\nPurpose\nIncreasing utilization of medications that treat opioid use disorders (MOUD) remains an essential strategy to curb the opioid crisis nationwide, especially among rural areas where access can present challenges. Washington State expanded access to MOUD through its opioid treatment networks (OTN), which provide low‐barrier access to MOUD in non‐traditional settings with an emphasis on buprenorphine and rural locations. We examined changes in buprenorphine utilization between Medicaid beneficiaries who initiated treatment at OTNs compared to individuals outside OTN facilities and by rural–urban residence.\n\n\nMethods\nWe used comparative time‐series analyses to examine longitudinal patterns of buprenorphine utilization among a sample (n = 93,401) of age 18 to 64 Washington State Medicaid beneficiaries diagnosed with OUD between 2019 and 2022. Monthly aggregated rates of buprenorphine utilization, stratified by OTN versus non‐OTN and rural–urban residence, were calculated for analysis.\n\n\nFindings\nBetween 2019 and 2022, rates of buprenorphine utilization were significantly higher among Medicaid beneficiaries initiating treatment at OTNs compared to beneficiaries treated at non‐OTN facilities regardless of rural–urban status. Furthermore, utilization was most prevalent among rural OTNs (β = 25.5, SE = 1.91, p < 0.001, 95% CI 21.7, 29.2). Despite increases in OUD prevalence, buprenorphine rates remained consistent during the study period, except for a decrease within micropolitan OTNs.\n\n\nConclusions\nWashington's OTN provides an example of one strategy that may support greater prescribing of buprenorphine and help mitigate the opioid crisis in small town/rural areas. Except among micropolitan areas, OTNs were able to keep pace in buprenorphine utilization despite demand from increased OUD prevalence.\n\n"]