Christopher W Jones1, Zachary Christman2, Christopher M Smith3, Michelle R Safferman4, Matthew Salzman5, Kaitlan Baston6, Rachel Haroz7. 1. Cooper Medical School of Rowan University, Department of Emergency Medicine, One Cooper Plaza, Camden, NJ 08103, USA. Electronic address: jones-christopher@cooperhealth.edu. 2. Department of Geography, Planning, and Sustainability, Rowan University, 201 Mullica Hill Road, Glassboro, NJ 08028, USA. Electronic address: christmanz@rowan.edu. 3. Cooper Medical School of Rowan University, Department of Emergency Medicine, One Cooper Plaza, Camden, NJ 08103, USA. Electronic address: smith-christopher@CooperHealth.edu. 4. Cooper Medical School of Rowan University, Department of Emergency Medicine, One Cooper Plaza, Camden, NJ 08103, USA. Electronic address: saffermam7@rowan.edu. 5. Cooper Medical School of Rowan University, Department of Emergency Medicine, One Cooper Plaza, Camden, NJ 08103, USA. Electronic address: Salzman-Matthew@CooperHealth.edu. 6. Cooper Medical School of Rowan University, Department of Internal Medicine, Three Cooper Plaza, Camden, NJ 08103, USA. Electronic address: Baston-Kaitlan@CooperHealth.edu. 7. Cooper Medical School of Rowan University, Department of Emergency Medicine, One Cooper Plaza, Camden, NJ 08103, USA. Electronic address: haroz-rachel@CooperHealth.edu.
Abstract
BACKGROUND: Buprenorphine is an effective medication for the treatment of opioid addiction, but current barriers to buprenorphine access limit treatment availability for many patients. We identify and characterize regions within the United States (US) with poor buprenorphine access relative to the observed burden of overdose deaths. METHODS: This cross sectional study includes US county-level data on the number of available buprenorphine providers (Substance Abuse and Mental Health Services Administration Buprenorphine Treatment Practitioner Locator) and the number of opioid-related overdose deaths between 2013 and 2015 (Centers for Disease Control and Prevention WONDER Database). Counties with fewer than 10 deaths during this time period were excluded to maintain patient privacy. Population-adjusted county death rates and provider availability were compared to identify locations with high disease burdens and limited buprenorphine access. The presence of significant clustering across the dataset was evaluated using Global Moran's I and zones of significant spatial clusters and anomalies were identified using Local Indicator of Spatial Autocorrelation. RESULTS: County data were available for 846 counties from 49 states and the District of Columbia, comprising 83% of the US population. The median number of opioid overdose deaths per county was 20.0 deaths per 100,000 residents (interquartile range 13.4-29.9, range 2.9 to 108.8). The number of buprenorphine providers per 100,000 county residents ranged from 0 to 45, with a median of 5.9 (interquartile range 3.2 to 9.5). Global Moran's I analysis yielded significant clustering in the distribution of both providers and deaths, with notable significant clusters of higher than average providers and deaths in the Northeast, and scattered mismatched regions of lower-than-average providers and higher-than-average deaths across the Southern, Midwestern, and Western US. Graphical analysis of buprenorphine provider availability and overdose burden reveals limited treatment access relative to overdose deaths throughout much of the Midwestern and Southern US. CONCLUSIONS: Substantial county-level imbalances between the availability of buprenorphine providers and the burden of opioid overdose deaths are present within the US.
BACKGROUND:Buprenorphine is an effective medication for the treatment of opioid addiction, but current barriers to buprenorphine access limit treatment availability for many patients. We identify and characterize regions within the United States (US) with poor buprenorphine access relative to the observed burden of overdose deaths. METHODS: This cross sectional study includes US county-level data on the number of available buprenorphine providers (Substance Abuse and Mental Health Services Administration Buprenorphine Treatment Practitioner Locator) and the number of opioid-related overdose deaths between 2013 and 2015 (Centers for Disease Control and Prevention WONDER Database). Counties with fewer than 10 deaths during this time period were excluded to maintain patient privacy. Population-adjusted county death rates and provider availability were compared to identify locations with high disease burdens and limited buprenorphine access. The presence of significant clustering across the dataset was evaluated using Global Moran's I and zones of significant spatial clusters and anomalies were identified using Local Indicator of Spatial Autocorrelation. RESULTS: County data were available for 846 counties from 49 states and the District of Columbia, comprising 83% of the US population. The median number of opioid overdose deaths per county was 20.0 deaths per 100,000 residents (interquartile range 13.4-29.9, range 2.9 to 108.8). The number of buprenorphine providers per 100,000 county residents ranged from 0 to 45, with a median of 5.9 (interquartile range 3.2 to 9.5). Global Moran's I analysis yielded significant clustering in the distribution of both providers and deaths, with notable significant clusters of higher than average providers and deaths in the Northeast, and scattered mismatched regions of lower-than-average providers and higher-than-average deaths across the Southern, Midwestern, and Western US. Graphical analysis of buprenorphine provider availability and overdose burden reveals limited treatment access relative to overdose deaths throughout much of the Midwestern and Southern US. CONCLUSIONS: Substantial county-level imbalances between the availability of buprenorphine providers and the burden of opioid overdose deaths are present within the US.
Authors: Ryan Marino; Jeanmarie Perrone; Lewis S Nelson; Timothy J Wiegand; Evan S Schwarz; Paul M Wax; Andrew I Stolbach Journal: J Med Toxicol Date: 2019-08-14
Authors: Valerie S Harder; Andrea C Villanti; Sarah H Heil; M Lindsey Smith; Diann E Gaalema; Marjorie C Meyer; Nathaniel H Schafrick; Stacey C Sigmon Journal: Prev Med Date: 2021-08-16 Impact factor: 4.018
Authors: Hilary S Connery; Nadine Taghian; Jungjin Kim; Margaret Griffin; Ian R H Rockett; Roger D Weiss; R Kathryn McHugh Journal: Drug Alcohol Depend Date: 2019-10-05 Impact factor: 4.492
Authors: Suzan Iloglu; Paul J Joudrey; Emily A Wang; Thomas A Thornhill; Gregg Gonsalves Journal: Drug Alcohol Depend Date: 2021-01-19 Impact factor: 4.492
Authors: Magdalena Cerdá; Noa Krawczyk; Leah Hamilton; Kara E Rudolph; Samuel R Friedman; Katherine M Keyes Journal: Annu Rev Public Health Date: 2021-11-30 Impact factor: 21.981
Authors: Miranda G Greiner; Matisyahu Shulman; Tse-Hwei Choo; Jennifer Scodes; Martina Pavlicova; Aimee N C Campbell; Patricia Novo; Marc Fishman; Joshua D Lee; John Rotrosen; Edward V Nunes Journal: J Subst Abuse Treat Date: 2021-04-30
Authors: Ashish P Thakrar; David Furfaro; Sara Keller; Ryan Graddy; Megan Buresh; Leonard Feldman Journal: J Hosp Med Date: 2021-06 Impact factor: 2.899