Public transport access to drug treatment before and during COVID-19: Implications for the opioid epidemic

Gazi, Yücel Shiv; Higgins, Christopher D.; Kumar, Gupta; Palm, Matthew

doi:10.1016/j.drugpo.2023.104032

Cited by 2 publications

(2 citation statements)

References 59 publications

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“…We focus on OTPs as they are the exclusive source for methadone under current regulations. Prior studies examining transportation barriers for OUD have investigated differences in travel time by car or public transit between proxies for individual treatment need and treatment services . A few studies have demonstrated the impact of distance or travel time by car to OUD treatment and adverse outcomes, with 1 of these studies assessing the impact by individual demographics .…”

Section: Introductionmentioning

confidence: 99%

“…Prior studies examining transportation barriers for OUD have investigated differences in travel time by car or public transit between proxies for individual treatment need and treatment services. 5 , 6 , 7 , 8 , 9 , 10 A few studies have demonstrated the impact of distance or travel time by car to OUD treatment and adverse outcomes, with 1 of these studies assessing the impact by individual demographics. 11 , 12 , 13 However, these studies have not integrated the following 2 key features of travel burdens.…”

Section: Introductionmentioning

confidence: 99%

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Accessibility of Opioid Treatment Programs Based on Conventional vs Perceived Travel Time Measures

Kim,

Lee,

Thornhill

et al. 2024

JAMA Netw Open

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ImportanceTransportation barriers have long been associated with poorer health outcomes; this burden is especially acute for individuals with opioid use disorder (OUD), a chronic disease often associated with low socioeconomic status. Conventional travel time analyses may not fully account for experiential components of travel, thereby understating the true travel burden and overstating treatment accessibility to opioid treatment programs (OTPs).ObjectiveTo develop a metric of feels-like accessibility for those using public transit to access OTPs that accounts for the realistic travel burden on individuals with OUD.Design, Setting, and ParticipantsThis cross-sectional study integrated high-resolution transit schedules and operating hours of OTPs to measure feels-like accessibility. Feels-like accessibility considers the differential outcomes of out-of-vehicle travel components and more realistically reflects individuals’ transportation burden than conventional accessibility measures. Gini indices and spatial regression models were used to investigate inequities in accessibility. Geocoded data for residential addresses of 1018 overdose fatalities in Connecticut in 2019 were used as a proxy for the treatment needs of individuals with OUD. Data were analyzed between May and August 2023.Main Outcomes and MeasuresConventional and feels-like accessibility scores.ExposuresFluctuations in public transit frequencies over the course of the day and the limited operating hours of the OTPs.ResultsOf the 1018 individuals in the study, the mean (SD) age at death was 43.7 (12.6) years, 784 individuals (77%) were men, 111 (11%) were African American, and 889 (87%) were White, with other racial and ethnic categories including 18 individuals (2%). A total of 264 individuals in the sample (26%) could not access an OTP within 180 minutes. For those who could access these facilities, the average 1-way travel time was 45.6 minutes, with individuals spending approximately 70% of their trip duration on out-of-vehicle travel components. The conventional accessibility metric underestimates individuals’ travel burden to OTPs as well as the inequity in accessibility compared with the feels-like accessibility metric. For example, the median (range) conventional accessibility score, defined as the number of OTPs within 120 minutes of transit travel time, was 5.0 (0.0-17.0); the median (range) feels-like accessibility score, defined as the number of OTPs within 120 minutes of transit travel time weighted to account for in- and out-of-vehicle segments, was 1.0 (0.0-10.0). There is a considerable temporal variation in travel time and accessibility depending on the departure times.Conclusions and RelevanceIn this cross-sectional study of travel burdens, the calculated feels-like accessibility scores, which consider the differential outcomes of out-of-vehicle travel components (eg, walking and waiting), could better and more realistically reflect passengers’ transportation burden. Policy recommendations derived from the conventional accessibility metric could be misleading, and decision-makers should use feels-like accessibility metrics that adequately capture individuals’ travel burdens. In the context of access to OTPs, the findings from this study suggest that opening new OTP sites to address gaps in access due to distance to services or extending hours of operation at existing sites may ameliorate the travel burden for individuals.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Accessibility of Opioid Treatment Programs Based on Conventional vs Perceived Travel Time Measures

Kim,

Lee,

Thornhill

et al. 2024

JAMA Netw Open

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Accessibility of methadone treatment via public transit for syringe services program participants in Miami-Dade County, Florida

Plesons,

Malecki,

Ciraldo

et al. 2024

Preprint

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Methadone is an opioid receptor agonist medication used in the treatment of opioid use disorder (OUD). Geographic distance to opioid treatment programs (OTPs) is a major barrier to treatment, given requirements for direct observation of dosing and periodic drug screens, and ‘methadone treatment deserts’ are defined as a public transit threshold of 30 minutes. The purpose of this study was to examine public transit access to methadone treatment for participants of a syringe services program (SSP) in Miami-Dade County, Florida. Public transit times were calculated using the R library r5r, which facilitates multi-modal transportation network routing. General Transit Feed Specification data was combined with street network data from OpenStreetMap for Miami-Dade County. Transit times were estimated from the population-weighted centroid of each zip code (n=79) with participants of Miami’s only SSP (n=1597) to the nearest OTP (n=4) using 10 departure windows aligned with OTP service hours. The mean one-way transit time from zip codes with SSP participants in Miami-Dade County to the nearest OTP was 80 minutes. 75 of the 79 (95%) zip codes with SSP participants in Miami-Dade County have a mean transit time to the closest OTP greater than 30 minutes. Transit times differ substantially between zip codes with different numbers of SSP participants, but not between departure windows. Nearly all zip codes with SSP participants in Miami-Dade County can be classified as ‘methadone treatment deserts’. Geographic isolation of methadone treatment from public transit routes represents a significant barrier to equitable OUD treatment.

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Public transport access to drug treatment before and during COVID-19: Implications for the opioid epidemic

Cited by 2 publications

References 59 publications

Accessibility of Opioid Treatment Programs Based on Conventional vs Perceived Travel Time Measures

Accessibility of Opioid Treatment Programs Based on Conventional vs Perceived Travel Time Measures

Accessibility of methadone treatment via public transit for syringe services program participants in Miami-Dade County, Florida

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