Disparities in Access to Opioid Treatment Programs and Office-Based Buprenorphine Treatment Across the Rural-Urban and Area Deprivation Continua: A US Nationwide Small Area Analysis

Abstract

Objectives: To measure access to opioid treatment programs (OTPs) and office-based buprenorphine treatment (OBBTs) at the smallest geographic unit for which the Census Bureau publishes demographic and socioeconomic data (ie, block group) and to explore disparities in access to treatment across the rural-urban and area deprivation continua across the United States.Methods: Access to OTPs and OBBTs at the block group in 2019 was quantified using an innovative 2-step floating catchment area technique that accounts for the supply of treatment facilities relative to the population size, proximity of facilities relative to the location of population in block groups, and time as a barrier within catchments. Block groups were stratified into tertiles based on the rural-urban continuum codes (metropolitan, micropolitan, small town, or rural) and area deprivation index (least-deprived, middle-deprived, most-deprived). The Integrated Nested Laplace Approximation approach was used for statistical analysis.Results: Across the United States, 3329 block groups corresponding to 2 915 949 adults lacked access to OTPs within a 2-hour drive of their community and 130 block groups corresponding to 86 605 adults did not have access to OBBTs. Disparities in access to treatment were observed across the urban-rural and area deprivation continua including (1) lowest mean access score to OBBTs were found among most-deprived small towns, and (2) lower mean access score to OTPs were found among micropolitan and small towns. Conclusions:The results of this study revealed disparities in access to medication-assisted treatment. The findings call for creative initiatives and local and regional policies to develop to mitigate access problems.

Community social vulnerability and access to medications for opioid use disorder within the continental US: A cross-sectional study

“…We improve upon previous research by utilizing two measures of small area (zip code tabulation area) geographic access (drive time and count of near locations) to all three types of MOUD, while incorporating two sources of extended-release naltrexone location data. Our results are consistent with previous research showing communities with lower socioeconomic status have less geographic access to methadone and buprenorphine,(44) and we extend these findings to extended-release naltrexone. By examining the four SVI themes, we find that communities vulnerable due to housing type and transportation also do not have greater geographic access to MOUD and may experience increased mortality during natural disasters and pandemics.…”

“…We build upon past work by showing that urban-rural inequities were present for all measures of access to buprenorphine and methadone, as well as extended-release naltrexone, including drive time, count of nearby locations, and count of locations per population at risk. (8,44,48) Drive times were significantly longer for methadone and extended-release naltrexone relative to dialysis centers, despite the prevalence of OUD being greater than ESRD. (8,49,50) A novel finding of this study is that the mismatch between overall social vulnerability and the location of MOUD services was greatest in suburban zip codes as compared to rural and urban zip codes and does not exist for people with end stage renal disease.…”

“…We build upon past work by showing that urban-rural inequities were present for all measures of access to buprenorphine and methadone, as well as extended-release naltrexone, including drive time, count of nearby locations, and count of locations per population at risk. (8,44,48) Drive times were significantly longer for methadone and extended-release naltrexone relative to dialysis centers, despite the prevalence of OUD being greater than ESRD. (8,49,50)…”

“…However, our results are consistent with previous research utilizing a gravity model approach to examine the urban-rural associations between socioeconomic status and access to buprenorphine and methadone. (44) Gravity models aim to account for the capacity of treatment locations and the spatial demand for treatment services. However, gravity model approaches currently require a priori assumptions about the ability to travel for MOUD treatment and the capacity of MOUD treatment locations both of which will vary spatially.…”

Opioid Misuse: A Global Crisis

“…Amiri et al's research further points out that .85% of people suffering from OUD have limited or no access to specialty centers near their home that can prescribe and dispense medications for OUD. 9 Zhou et al provide evidence from Medicare claims data that illustrate the complexity of designing an appropriate regimen, where effectiveness and total cost of a treatment program is related to the level of initial opioid use and whether opioid agonists are used alone or in combination with gabapentinoids. 10 These studies collectively add to the understanding that there was a substantial delay in recognizing the crisis for what it might become, the difficulties of initiating both prevention and treatment responses, and some proposed solutions.…”