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. 2021 Nov 1:228:109081.
doi: 10.1016/j.drugalcdep.2021.109081. Epub 2021 Sep 24.

Robustness of estimated access to opioid use disorder treatment providers in rural vs. urban areas of the United States

Mathew V Kiang  1 , Michael L Barnett  2 , Sarah E Wakeman  3 , Keith Humphreys  4 , Alexander C Tsai  5
Affiliations

Robustness of estimated access to opioid use disorder treatment providers in rural vs. urban areas of the United States

Mathew V Kiang et al. Drug Alcohol Depend. .

Abstract

Background: Effective, evidence-based treatments for opioid use disorder are not equally accessible to Americans. Recent studies have found urban/rural disparities in the driving times to the nearest opioid treatment providers. These disparities may be even worse than currently reported in the literature because patients may not be able to obtain appointments with their nearest provider. We examine the robustness of the opioid treatment infrastructure by estimating how driving times to treatment change as provider availability decreases.

Methods: We used public data from the federal government to estimate the driving time from each census tract centroid to the nearest 15 treatment providers. We summarized the median and interquartile range of driving times to increasingly distant providers (i.e., nearest, second nearest, etc.), stratified by urban/rural classification.

Results: The median driving time to the nearest provider was greater in rural areas than urban areas for both opioid treatment programs (12 min vs 61 min) and buprenorphine-waivered prescribers (5 min vs 21 min). Importantly, driving times in rural areas increased more steeply as nearer providers became unavailable. For example, the increase in driving time between the nearest provider and the fifth nearest provider was much greater in rural areas than in urban areas for both buprenorphine-waivered prescribers (23 min vs 4 min) and for opioid treatment programs (54 min vs 22 min).

Conclusions: Access to treatment for opioid use disorder is more robust in urban areas compared with rural areas. This disparity must be eliminated if the opioid overdose crisis is to be resolved.

Keywords: Opioids; Substance use; Treatment; Urban-rural inequality.

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Conflict of interest statement

Conflicts of Interest

Dr. Barnett reports being retained as an expert witness by plaintiffs in lawsuits against opioid manufacturers. All other authors have no conflicts to declare.

Figures

Figure 1.
Figure 1.
Median (points) and interquartile range (IQR; shaded regions) of driving time from census tract centroids to the 15 nearest opioid treatment providers, by urban (blue) vs. rural (orange) classification code. Note: The magnitude of the y-axis differs between the top and bottom rows. Numerical representations of these data are available in the Supplement.
Figure 2.
Figure 2.
Median increase in driving time between the nearest opioid treatment provider and the 5th nearest opioid treatment provider.
See this image and copyright information in PMC

References

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