Medication for opioid use disorder less accessible in rural counties
Rural counties in the United States had lower odds of reaching maximum potential buprenorphine treatment capacity, according to findings published in Drug and Alcohol Dependence.
Counties with high populations of people with disabilities or without insurance also had lower odds of maximum treatment capacity with buprenorphine, a medication for opioid use disorder (MOUD).
“Some of the strongest associations in our models were when comparing metropolitan counties with micropolitan and rural counties,” Brian Corry, MA, of the division of overdose prevention at the CDC’s National Center for Injury Prevention and Control, and colleagues wrote. “Across the models, availability of MOUD was lower in micropolitan and rural counties.”
The study supports previous research demonstrating disparities in buprenorphine access, as well as a CDC analysis that revealed higher rates of overdose deaths in rural vs. urban counties in California, Connecticut, North Carolina, Vermont and Virginia in 2019.
“Availability of MOUD is a persistent issue in rural areas and our findings suggest that these barriers remain,” the researchers wrote.
Corry and colleagues used county-level Drug Enforcement Administration (DEA) data to determine the presence, absence and availability of buprenorphine treatment or opioid treatment programs (OTPs) in counties in the U.S. Specifically, they analyzed data from the DEA Controlled Substances Registrant File up to Dec. 31, 2019, and extracted all clinicians with a Drug Addiction Treatment Act of 2000 (DATA) waiver.
According to the researchers, DATA-waived clinicians have a maximum authorized patient limit of 30, 100 or 275. They determined a county’s maximum potential buprenorphine treatment capacity based on the number of DATA-waived clinicians in the county and their maximum authorized patient limit capacity, as well as county-level counts of OTPs registered with the DEA.
In total, 3,201 counties were assessed, of which 78.3% did not have an OTP and 29.4% had no DATA-waived clinicians, the researchers reported. Overall, the odds ratio of any county having at least one OTP was 1.01 (95% CI, 0.64-1.6). The odds of having OTP availability were higher for counties with higher percentages of non-Hispanic Black (OR = 1.03; 95% CI, 1.02-1.04) and Hispanic populations (OR = 1.03; 95% CI, 1.02-1.04), as well as counties with higher rates of drug overdose deaths (OR = 1.07; 95% CI, 1.05-1.08). Corry and colleagues also reported that the odds of having one or more OTP for counties with higher percentages of people without health insurance was 0.95 (95% CI, 0.92-0.98) and 0.88 for counties with high percentages of people with a disability (95% CI, 0.85-0.92). Micropolitan (OR = 0.3; 95% CI, 0.23-0.4) and rural counties (OR = 0.05; 95% CI, 0.03-0.07) had lower odds of having at least one OTP compared with metropolitan counties.
The baseline odds for any county having at least one DATA-waived clinician was 2.52 (95% CI, 1.68-3.77), according to the researchers. Counties with higher percentages of people in poverty (OR = 1.04; 95% CI, 1.02-1.06) and a higher rate of drug overdoses (OR = 1.1; 95% CI, 1.08-1.12) had higher odds for reaching maximum potential DATA-waived buprenorphine treatment capacity.
“Given the acceleration of the overdose crisis in the U.S., expanding equitable access to medication for opioid use disorder (MOUD) is critical,” Corry and colleagues wrote. “This includes the development and implementation of public health strategies that prioritize areas and populations of greatest need to improve equitable access to MOUD.”
References:
Corry B, et al. Drug Alcohol Depend. 2022;doi:10.1016/j.drugalcdep.2022.109495.
Urban–rural differences in drug overdose death rates, 1999–2019. https://www.cdc.gov/nchs/data/databriefs/db403-H.pdf. Published March 2021. Accessed May 19, 2022.