Paul J Joudrey1, Nicholas Chadi2, Payel Roy3, Kenneth L Morford4, Paxton Bach5, Simeon Kimmel6, Emily A Wang4, Susan L Calcaterra7. 1. Department of Internal Medicine, Yale School of Medicine, 367 Cedar Street, Harkness Hall A, New Haven, CT, 06520, USA. Electronic address: paul.joudrey@yale.edu. 2. Department of Pediatrics, Sainte-Justine University Hospital Centre, 3175 Chemin de la Cote Ste-Catherine, Montreal, QC, H3T 1C5, Canada. 3. Department of Medicine, University of Pittsburgh School of Medicine, 3550 Terrace St, Pittsburgh, PA, 15213, USA. 4. Department of Internal Medicine, Yale School of Medicine, 367 Cedar Street, Harkness Hall A, New Haven, CT, 06520, USA. 5. Department of Medicine, University of British Columbia and the British Columbia Center on Substance Use, 1045 Howe St Suite 400, Vancouver, BC, V6Z 2A9, Canada. 6. Department of Medicine, Boston Medical Center and Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Building, 2nd Floor, Boston, MA, 02118, USA. 7. Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Academic Office One, 12631 East 17th Avenue, Aurora, CO, 80045, USA.
Abstract
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.
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 overdosedeaths. 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.
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