Geographic variation in availability of opioid treatment programs across U.S. communities

Abstract

Methadone for Opioid Use Disorder (OUD) treatment is only dispensed at Opioid Treatment Programs (OTPs). Little is known about the geographic variation in OTP availability and community characteristics associated with the availability across smaller geographic communities in the U.S. To (1) describe geographic distribution of OTPs and (2) examine OTP availability by community characteristics in the contiguous U.S. at Zip Code Area Tabulation (ZCTA) level. Logistic regression was used to examine community characteristics associated with OTP availability (N = 30,367). Chi-square and t-tests were conducted to examine statistically significant differences in OTP availability. Maps and descriptive statistics were used to examine geographic variation in OTP availability. Only 5% (1,417) of ZCTAs had at least one OTP for a total of 1,682 OTPs. Rural ZCTAs had 50% lower odds of having an OTP compared to urban ZCTAs [AOR 0.5; (95% CI: 0.41–0.60)]. ZCTAs in the lowest income quartile had higher odds of having an OTP compared to ZCTAs in the highest income quartile [AOR 3.4; (95% CI: 2.71–4.18)]. Further, ZCTAs with OTPs had a higher proportion of minority residents [Black: 17.5% vs. 7.2%; Hispanic: 19.2% vs. 9%] and a lower proportion of White residents [55.1% vs. 78.2%]. Nationally, OTPs are extremely scarce with notable regional and urban-rural disparities. Potential solutions to address these disparities are discussed.

Keywords:

• Opioid treatment programs
• medication-assisted treatment
• access to opioid treatment
• health disparities
• geospatial analysis

Authors’ contributions

The authors responsibilities were as follows—SJ designed the study, conducted the statistical analysis, and wrote the first draft of the manuscript. WZ, NW, and KS participated in the interpretation of the study results, critical revisions, and approval of the final version of the manuscript.

Disclosure statement

The authors report no conflicts of interest and have no financial interests to disclose.

Data availability statement

The data that support the findings of this study is available from the corresponding author, [SJ], upon reasonable request.

Additional information

Funding

Work on this article by Kristen D. Seay was supported in part by the National Institute of General Medical Sciences of the National Institutes of Health (NIH) for the UofSC Research Center for Child Well-Being under Award Number P20GM130420. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.