Background: Within the United States, there is a shortage of opioid treatment programs (OTPs), facilities which dispense methadone for opioid use disorder. It is unknown how pharmacy-based methadone dispensing, as available internationally, could affect methadone access. We aimed to compare drive times to the nearest OTP with drive times to the nearest chain pharmacy in urban and rural census tracts.
Methods: Cross-sectional geospatial analysis of 2018 OTP location data and 2017 pharmacy location data. We included census tracts with non-zero population in Indiana, Kentucky, Ohio, Virginia, and West Virginia, states with highest rates of opioid overdose deaths. Our outcome was minimum drive time in minutes from census tract mean center of population to the nearest dispensing facility.
Results: Among 7918 census tracts, median (IQR) drive time to OTPs increased from urban to increasingly rural census tract classification [16.1 min (10.2-25.9) to 48.4 min (34.0-63.3);p < .001]. Median (IQR) drive time to OTPs was greater than drive time to chain pharmacies among all census tracts: 19.6 min (11.6-35.1) versus 4.4 min (2.9-7.7) respectively; p < .001. The median (IQR) difference in drive time was greater for increasingly rural census tracts [11.5 min (6.1-19.2) to 35.2 min (19.6-49.7); p <.001] with pharmacy-based methadone dispensing.
Conclusion: Rural census tracts have disproportionately long drive times to OTPs. Drawing from policies to increase methadone access in countries like Canada and Australia, this geographic methadone disparity could be mitigated through implementation of pharmacy-based methadone dispensing.
Keywords: Access; Methadone; Opioid use disorder; Pharmacy.
Copyright © 2020 Elsevier B.V. All rights reserved.
Conflict of interest statement
Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: SK consults for Abt associates on a Department of Public Health project to expand access to medications for opioid use disorder in post-acute care facilities. All authors have no additional declarations or conflict of interests to report.
Rurality and differences in pharmacy characteristics and community factors associated with provision of naloxone in the pharmacy.Int J Drug Policy. 2019 Nov 15:102602. doi: 10.1016/j.drugpo.2019.11.010. Online ahead of print. Int J Drug Policy. 2019. PMID: 31740174
Vital Signs: Pharmacy-Based Naloxone Dispensing - United States, 2012-2018.MMWR Morb Mortal Wkly Rep. 2019 Aug 9;68(31):679-686. doi: 10.15585/mmwr.mm6831e1. MMWR Morb Mortal Wkly Rep. 2019. PMID: 31393863 Free PMC article.
Suboptimal geographic accessibility to comprehensive HIV care in the US: regional and urban-rural differences.J Int AIDS Soc. 2019 May;22(5):e25286. doi: 10.1002/jia2.25286. J Int AIDS Soc. 2019. PMID: 31111684 Free PMC article.
Trends in the Use of Methadone and Buprenorphine at Substance Abuse Treatment Facilities: 2003 to 2011.2013 Apr 23. In: The CBHSQ Report. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013–. The CBHSQ Report. 2013–. PMID: 27606405 Free Books & Documents. Review.
Services Offered by Outpatient-Only Opioid Treatment Programs: 2012.2014 Oct 23. In: The CBHSQ Report. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013–. The CBHSQ Report. 2013–. PMID: 27606408 Free Books & Documents. Review.