Robert A Kleinman1. 1. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
Abstract
Importance: Methadone maintenance is an effective treatment of opioid use disorder, but federal regulations in the US restrict methadone dispensing to opioid treatment programs (OTPs). In Australia, Canada, and the UK, patients can obtain methadone maintenance from community pharmacies. Objective: To compare driving access to methadone maintenance treatment between OTP and pharmacy dispensing models. Design, Setting, and Participants: This descriptive cross-sectional study assessed driving times from census tract mean centers of population to OTPs and pharmacies. Census tracts from the 50 US states and the District of Columbia (based on the 2010 US Census) were included if their population was greater than 0, if their mean center of population (MCP) was within 3 miles of the road network, and if the 1-way driving times from the census tract MCP to both an OTP and a pharmacy were 12 hours or less. Data analyses were performed from November 15, 2019, to April 18, 2020. Main Outcomes and Measures: The primary outcome was the population-weighted mean driving time from census tract MCPs to OTPs and pharmacies in the US. Census tract MCPs are population-weighted geographic centroids of residents living in each census tract. Driving times were estimated using historical average driving speeds. Results: All 1682 unique locations of OTPs were included, and 69 475 unique pharmacy locations were included after geocoding. A total of 72 443 census tracts were included in the analysis. The mean population-weighted driving time from census tract MCPs was 20.4 minutes (95% CI, 20.3-20.6 minutes) to OTPs and 4.5 minutes (95% CI, 4.4-4.5 minutes) to pharmacies (P < .001). Differences in driving time, distance, and cost between 1-way trips ending at OTPs and pharmacies were largest in micropolitan and noncore counties. Conclusions and Relevance: In this study, population-weighted mean driving times from US census tract MCPs were longer to OTPs than to pharmacies.
Importance: Methadone maintenance is an effective treatment of opioid use disorder, but federal regulations in the US restrict methadone dispensing to opioid treatment programs (OTPs). In Australia, Canada, and the UK, patients can obtain methadone maintenance from community pharmacies. Objective: To compare driving access to methadone maintenance treatment between OTP and pharmacy dispensing models. Design, Setting, and Participants: This descriptive cross-sectional study assessed driving times from census tract mean centers of population to OTPs and pharmacies. Census tracts from the 50 US states and the District of Columbia (based on the 2010 US Census) were included if their population was greater than 0, if their mean center of population (MCP) was within 3 miles of the road network, and if the 1-way driving times from the census tract MCP to both an OTP and a pharmacy were 12 hours or less. Data analyses were performed from November 15, 2019, to April 18, 2020. Main Outcomes and Measures: The primary outcome was the population-weighted mean driving time from census tract MCPs to OTPs and pharmacies in the US. Census tract MCPs are population-weighted geographic centroids of residents living in each census tract. Driving times were estimated using historical average driving speeds. Results: All 1682 unique locations of OTPs were included, and 69 475 unique pharmacy locations were included after geocoding. A total of 72 443 census tracts were included in the analysis. The mean population-weighted driving time from census tract MCPs was 20.4 minutes (95% CI, 20.3-20.6 minutes) to OTPs and 4.5 minutes (95% CI, 4.4-4.5 minutes) to pharmacies (P < .001). Differences in driving time, distance, and cost between 1-way trips ending at OTPs and pharmacies were largest in micropolitan and noncore counties. Conclusions and Relevance: In this study, population-weighted mean driving times from US census tract MCPs were longer to OTPs than to pharmacies.
Authors: Elizabeth C Saunders; Alan J Budney; Patricia Cavazos-Rehg; Emily Scherer; Lisa A Marsch Journal: Prev Med Date: 2021-09-07 Impact factor: 4.018
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: Paul J Joudrey; Gavin Bart; Robert K Brooner; Lawrence Brown; Julie Dickson-Gomez; Adam Gordon; Sarah S Kawasaki; Jane M Liebschutz; Edward Nunes; Dennis McCarty; Robert P Schwartz; José Szapocnik; Madhukar Trivedi; Judith I Tsui; Arthur Williams; Li-Tzy Wu; David A Fiellin Journal: Subst Abus Date: 2021 Impact factor: 3.716
Authors: Mathew V Kiang; Michael L Barnett; Sarah E Wakeman; Keith Humphreys; Alexander C Tsai Journal: Drug Alcohol Depend Date: 2021-09-24 Impact factor: 4.492
Authors: Li-Tzy Wu; William S John; Eric D Morse; Steve Adkins; Jennifer Pippin; Robert K Brooner; Robert P Schwartz Journal: Addiction Date: 2021-08-16 Impact factor: 6.526
Authors: Dennis McCarty; Christina Bougatsos; Brian Chan; Kim A Hoffman; Kelsey C Priest; Sara Grusing; Roger Chou Journal: Am J Psychiatry Date: 2021-07-28 Impact factor: 19.242
Authors: Laura E Henkhaus; Melinda B Buntin; Sarah Clark Henderson; Pikki Lai; Stephen W Patrick Journal: Subst Abus Date: 2021-07-16 Impact factor: 3.716