Suzan Iloglu1, Paul J Joudrey2, Emily A Wang3, Thomas A Thornhill1, Gregg Gonsalves4. 1. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College St, New Haven, CT, 06510, USA. 2. Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA. Electronic address: paul.joudrey@yale.edu. 3. Department of Internal Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA. 4. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College St, New Haven, CT, 06510, USA; Yale Law School, 127 Wall St, New Haven, CT, 06511, USA.
Abstract
BACKGROUND: In the United States, methadone provision for opioid use disorder (OUD) occurs at opioid treatment programs (OTPs). Ohio recently enacted a policy to expand methadone administration to Federally Qualified Health Centers (FQHC). We compared how the provision of methadone at current OTPs or the proposed expansion to FQHCs and pharmacies meets the urban and rural need for OUD treatment. METHODS: Cross-sectional geospatial analysis of zip codes within Ohio with at least one 2017 opioid overdose death stratified by Rural-Urban Commuting Area codes. Our primary outcome was the proportion of need by zip code (using opioid overdose deaths as a proxy for need) within a 15- or 30- minute drive time of an OTP. RESULTS: Among 581 zip codes, sixty four percent of treatment need was within a 15-minute drive time and 81 %, within a 30-minute drive time. The proportion of need within a 15-minute drive decreased with increasing rural classification (urban 78 %, suburban 20 %, large rural 9%, and small rural 1%;p<.001). The portion of need within a 15-minute drive time increased with the addition of FQHCs (96 %) and the addition of chain pharmacies (99 %) relative to OTPs alone among all zip codes and for all urban-rural strata (p<.001). CONCLUSION: Over one-third of OUD treatment need was not covered by existing OTPs and coverage decreased with rural classification of zip codes. Most of the gap between supply and need could be mitigated with FQHC methadone provision, which would expand both urban and rural access.
BACKGROUND: In the United States, methadone provision for opioid use disorder (OUD) occurs at opioid treatment programs (OTPs). Ohio recently enacted a policy to expand methadone administration to Federally Qualified Health Centers (FQHC). We compared how the provision of methadone at current OTPs or the proposed expansion to FQHCs and pharmacies meets the urban and rural need for OUD treatment. METHODS: Cross-sectional geospatial analysis of zip codes within Ohio with at least one 2017 opioid overdose death stratified by Rural-Urban Commuting Area codes. Our primary outcome was the proportion of need by zip code (using opioid overdose deaths as a proxy for need) within a 15- or 30- minute drive time of an OTP. RESULTS: Among 581 zip codes, sixty four percent of treatment need was within a 15-minute drive time and 81 %, within a 30-minute drive time. The proportion of need within a 15-minute drive decreased with increasing rural classification (urban 78 %, suburban 20 %, large rural 9%, and small rural 1%;p<.001). The portion of need within a 15-minute drive time increased with the addition of FQHCs (96 %) and the addition of chain pharmacies (99 %) relative to OTPs alone among all zip codes and for all urban-rural strata (p<.001). CONCLUSION: Over one-third of OUD treatment need was not covered by existing OTPs and coverage decreased with rural classification of zip codes. Most of the gap between supply and need could be mitigated with FQHC methadone provision, which would expand both urban and rural access.
Authors: Solmaz Amiri; Robert B Lutz; Michael G McDonell; John M Roll; Ofer Amram Journal: Am J Drug Alcohol Abuse Date: 2019-06-25 Impact factor: 3.829
Authors: Paul J Joudrey; Zoe M Adams; Paxton Bach; Sarah Van Buren; Jessica A Chaiton; Lucy Ehrenfeld; Mary Elizabeth Guerra; Brynna Gleeson; Simeon D Kimmel; Ashley Medley; Wassim Mekideche; Maxime Paquet; Minhee Sung; Melinda Wang; R O Olivier You Kheang; Jingxian Zhang; Emily A Wang; E Jennifer Edelman Journal: JAMA Netw Open Date: 2021-07-01