TY - JOUR
KW - Analgesics, Opioid/therapeutic use
KW - Buprenorphine/therapeutic use
KW - COVID-19/drug therapy
KW - Cross-Sectional Studies
KW - Health Services Accessibility
KW - Humans
KW - Methadone/therapeutic use
KW - Naltrexone/therapeutic use
KW - Opiate Substitution Treatment/methods
KW - Opioid-Related Disorders/drug therapy/epidemiology
KW - United States/epidemiology
AU - P. J. Joudrey
AU - M. Kolak
AU - Q. Lin
AU - S. Paykin
AU - V. Anguiano Jr
AU - E. A. Wang
A1 - 
AB - IMPORTANCE: Given that COVID-19 and recent natural disasters exacerbated the shortage of medication for opioid use disorder (MOUD) services and were associated with increased opioid overdose mortality, it is important to examine how a community's ability to respond to natural disasters and infectious disease outbreaks is associated with MOUD access. OBJECTIVE: To examine the association of community vulnerability to disasters and pandemics with geographic access to each of the 3 MOUDs and whether this association differs by urban, suburban, or rural classification. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of zip code tabulation areas (ZCTAs) in the continental United States excluding Washington, DC, conducted a geospatial analysis of 2020 treatment location data. EXPOSURES: Social vulnerability index (US Centers for Disease Control and Prevention measure of vulnerability to disasters or pandemics). MAIN OUTCOMES AND MEASURES: Drive time in minutes from the population-weighted center of the ZCTA to the ZCTA of the nearest treatment location for each treatment type (buprenorphine, methadone, and extended-release naltrexone). RESULTS: Among 32 604 ZCTAs within the continental US, 170 within Washington, DC, and 20 without an urban-rural classification were excluded, resulting in a final sample of 32 434 ZCTAs. Greater social vulnerability was correlated with longer drive times for methadone (correlation, 0.10; 95% CI, 0.09 to 0.11), but it was not correlated with access to other MOUDs. Among rural ZCTAs, increasing social vulnerability was correlated with shorter drive times to buprenorphine (correlation, -0.10; 95% CI, -0.12 to -0.08) but vulnerability was not correlated with other measures of access. Among suburban ZCTAs, greater vulnerability was correlated with both longer drive times to methadone (correlation, 0.22; 95% CI, 0.20 to 0.24) and extended-release naltrexone (correlation, 0.15; 95% CI, 0.13 to 0.17). CONCLUSIONS AND RELEVANCE: In this study, communities with greater vulnerability did not have greater geographic access to MOUD, and the mismatch between vulnerability and medication access was greatest in suburban communities. Rural communities had poor geographic access regardless of vulnerability status. Future disaster preparedness planning should match the location of services to communities with greater vulnerability to prevent inequities in overdose deaths.
AD - Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; Healthy Regions & Policies Lab, Center for Spatial Data Science, University of Chicago, Chicago, Illinois.; Healthy Regions & Policies Lab, Center for Spatial Data Science, University of Chicago, Chicago, Illinois.; Healthy Regions & Policies Lab, Center for Spatial Data Science, University of Chicago, Chicago, Illinois.; Healthy Regions & Policies Lab, Center for Spatial Data Science, University of Chicago, Chicago, Illinois.; Program in Addiction Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.; SEICHE Center for Health and Justice, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
BT - JAMA network open
C5 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
CP - 4
CY - United States
DO - 10.1001/jamanetworkopen.2022.7028
IS - 4
JF - JAMA network open
LA - eng
M1 - Journal Article
N2 - IMPORTANCE: Given that COVID-19 and recent natural disasters exacerbated the shortage of medication for opioid use disorder (MOUD) services and were associated with increased opioid overdose mortality, it is important to examine how a community's ability to respond to natural disasters and infectious disease outbreaks is associated with MOUD access. OBJECTIVE: To examine the association of community vulnerability to disasters and pandemics with geographic access to each of the 3 MOUDs and whether this association differs by urban, suburban, or rural classification. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of zip code tabulation areas (ZCTAs) in the continental United States excluding Washington, DC, conducted a geospatial analysis of 2020 treatment location data. EXPOSURES: Social vulnerability index (US Centers for Disease Control and Prevention measure of vulnerability to disasters or pandemics). MAIN OUTCOMES AND MEASURES: Drive time in minutes from the population-weighted center of the ZCTA to the ZCTA of the nearest treatment location for each treatment type (buprenorphine, methadone, and extended-release naltrexone). RESULTS: Among 32 604 ZCTAs within the continental US, 170 within Washington, DC, and 20 without an urban-rural classification were excluded, resulting in a final sample of 32 434 ZCTAs. Greater social vulnerability was correlated with longer drive times for methadone (correlation, 0.10; 95% CI, 0.09 to 0.11), but it was not correlated with access to other MOUDs. Among rural ZCTAs, increasing social vulnerability was correlated with shorter drive times to buprenorphine (correlation, -0.10; 95% CI, -0.12 to -0.08) but vulnerability was not correlated with other measures of access. Among suburban ZCTAs, greater vulnerability was correlated with both longer drive times to methadone (correlation, 0.22; 95% CI, 0.20 to 0.24) and extended-release naltrexone (correlation, 0.15; 95% CI, 0.13 to 0.17). CONCLUSIONS AND RELEVANCE: In this study, communities with greater vulnerability did not have greater geographic access to MOUD, and the mismatch between vulnerability and medication access was greatest in suburban communities. Rural communities had poor geographic access regardless of vulnerability status. Future disaster preparedness planning should match the location of services to communities with greater vulnerability to prevent inequities in overdose deaths.
PP - United States
PY - 2022
SN - 2574-3805; 2574-3805
T1 - Assessment of Community-Level Vulnerability and Access to Medications for Opioid Use Disorder
T2 - JAMA network open
TI - Assessment of Community-Level Vulnerability and Access to Medications for Opioid Use Disorder
U1 - Education & Workforce; Healthcare Disparities; Opioids & Substance Use
U2 - 35438757
U3 - 10.1001/jamanetworkopen.2022.7028
VL - 5
VO - 2574-3805; 2574-3805
Y1 - 2022
Y2 - Apr 1
ER -