Disparities in Opioid Agonist Treatment Accessibility for Priority Populations in New South Wales, Australia

Abstract

Introduction: Opioid agonist treatment (OAT) is effective for managing opioid dependence; however, it can be hard to access in some regions. We investigated OAT access for priority populations living in New South Wales, Australia: Aboriginal and Torres Strait Islander peoples, Culturally and Linguistically Diverse (CALD) peoples, and youth (18-24 years).

Method: Using a linked database, we analysed distances between residential postcodes and OAT dosing points for 29,935 individuals from July 2015 to June 2020. We used multi-level models with random intercepts for clients to assess the relative distance lived from dosing points for members of each priority population.

Results: The median distance to dosing points was 9.80 km. Multi-level regression predicting log-transformed distance (ln) showed, relative to others, Aboriginal and Torres Strait Islander clients lived 89.98% (95% confidence interval [CI] 82.25%, 98.04%) further, and youth lived 15.09% (95% CI 4.70%, 26.52%) further from dosing points. In contrast, CALD individuals lived 35.32% (95% CI 31.88%, 38.58%) closer than others. Multi-level logistic regression showed Aboriginal and Torres Strait Islander clients were 3.39 (95% CI 2.82, 4.07) times more likely to live 50 km or more from their chosen dosing point.

Discussion and conclusion: Aboriginal and Torres Strait Islander Australians and youth have poorer access to OAT dosing points than others in New South Wales. CALD individuals live closer to dosing points, which could suggest better access, or reticence to travel far for care. Targeted interventions are needed to improve OAT accessibility in regional and remote areas.

Keywords: Indigenous peoples; cultural diversity; health services accessibility; opioid substitution treatment; young adult.

FIGURE 1

Median distances patients live from opioid agonist treatment dosing points by Statistical Area 3 (SA3), by population. (A) shows values for New South Wales, (B) shows values for Greater Sydney. Data based on the New South Wales Controlled Drugs Data Collection dataset. Direct distances measured from centroids of client postcodes to centroids of dosing point postcodes. Black patches indicate an absence of data. That is, fewer than 10 people in those locations accessed New South Wales Controlled Drugs Data Collection dosing points.