Communities with greater social vulnerability lack geographic access to opioid medication

Communities with greater social vulnerability did not have greater geographic access to medication for opioid use disorder, according to a study published in JAMA Network Open.

“It is important to examine how a community’s ability to respond to disasters and infectious disease outbreaks is associated with current access to [medication for opioid use disorder] especially given the already uneven access to the medications,” Paul J. Joudrey, MD, MPH, of the department of internal medicine at Yale School of Medicine, and colleagues wrote.

Joudrey and colleagues sought to examine associations between community vulnerability to climate-driven disasters and pandemics with geographic access to each of the three approved medications for opioid use disorder (MOUDs) and whether they differ along urban, suburban or rural strata.

The study was a cross-sectional geospatial analysis of more than 198 million individuals between the ages 18 and 64 years, within 32,432 U.S. ZIP code tabulation areas (ZCTA) excluding Washington, D.C., and other non-classified regions.

Census tract social vulnerability index data, which measures vulnerability across themes of socioeconomic status, household composition and density, racial and ethnic minority status and language, and housing type and transportation, were gained from the CDC. Geographic access to MOUDs was measured via the 2020 SAMHSA Behavioral Health Treatment Services Locator, location data from clinicians registered with naltrexone’s manufacturer taken in August 2020, as well as dialysis center location data from the CMS database in May 2020. The main outcome was drive time in minutes from the population-weighted center of the ZCTA to the ZCTA of the nearest treatment location for each of the three MOUDs.

Results showed that higher social vulnerability was correlated with longer drive times for methadone (95% CI, 0.09-0.11), but not for access to other MOUDs. Among rural ZCTAs, increasing social vulnerability was correlated with shorter drive times to buprenorphine (95% CI, –0.12 to –0.08), but not correlated with other measures of access. Among suburban ZCTAs, greater vulnerability was correlated with both longer drive times to methadone (95% CI, 0.20-0.24) and extended-release naltrexone (95% CI, 0.13-0.17).

For suburban ZCTAs, greater overall vulnerability was correlated with both longer drive times and fewer MOUD locations, with the median drive time to methadone increasing from the lowest to highest category of vulnerability for socioeconomic status, household composition and disability, and housing type and transportation.

Data additionally revealed that, for all treatment types, median drive time increased as rural ZCTA classification increased, while the median count of treatment locations within a 30-minute drive decreased.

“MOUD policy and delivery innovations need to address urban-rural inequities and better match the location of services to communities with greater social vulnerability to prevent inequities in opioid overdose deaths during future disasters,” Joudrey and colleagues wrote.