The most socially vulnerable communities do not have geographical access to opioid medications


April 20, 2022

2 minute read

Disclosures: Joudrey does not report any relevant financial information. Please see the study for relevant financial information from all other authors.

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According to a study published in Open JAMA Network.

“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 unequal access to medicines,” Paul J. JoudreyMD, MPH, from the Department of Internal Medicine at the Yale School of Medicine, and colleagues wrote.

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Joudrey and colleagues sought to examine associations between community vulnerability to climate-related disasters and pandemics with geographic access to each of the three approved drugs for opioid use disorder (MOUD) and s They differ according to urban, suburban or rural strata.

The study was a cross-sectional geospatial analysis of more than 198 million individuals between the ages of 18 and 64, in 32,432 U.S. ZIP Code Tabulation Areas (ZCTAs) excluding Washington, D.C., and other unnamed regions. classified.

Census Tract Social Vulnerability Index data, which measures vulnerability across the themes of socioeconomic status, household composition and density, racial and ethnic minority status and language, as well as type of accommodation and transportation, were obtained from the CDC. Geographic access to MOUDs was measured through the behavioral health treatment services locator SAMHSA 2020, location data of clinicians registered with the manufacturer of naltrexone taken in August 2020, as well as location data of dialysis centers from the CMS database in May 2020. The main output was the driving 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 driving times for methadone (95% CI, 0.09-0.11), but not for access to other MOUDs. Among rural ZCTAs, increased social vulnerability was correlated with shorter travel times to buprenorphine (95% CI, -0.12 to -0.08), but not correlated with other measures of vulnerability. ‘access. Among suburban ZCTAs, greater vulnerability was correlated with both longer driving times on 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 travel times and fewer MOUD locations, with median travel time to methadone increasing from the lowest vulnerability category to higher for socio-economic status, household composition and disability, as well as housing type and transportation.

The data further revealed that, for all treatment types, the median driving time increased as the rural ZCTA classification increased, while the median number of treatment locations within a 30-minute drive decreased.

“MOUD policy and delivery innovations must address urban-rural inequities and better tailor the location of services to the most socially vulnerable communities to prevent inequities in opioid overdose deaths in future disasters. “, wrote Joudrey and his colleagues.


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