Drive Time a Barrier to Opioid Treatment

Updated: Jan 15, 2020

ALLOWING METHADONE treatment that's currently available only in tightly regulated clinics to be provided in primary care settings could improve access to opioid addiction treatment in rural America, according to a new study.

Methadone is one of three drugs approved by the Food and Drug Administration to treat opioid dependence, along with buprenorphine and naltrexone, and the medications often are paired with counseling in an approach called medication-assisted treatment. But because methadone patients must take the drug each day and initially under physician supervision at federally certified clinics, public health experts and advocates have raised concerns about barriers to accessing this treatment – particularly in rural communities where the clinics can be few and far between.

"Methadone for opioid use disorder can be dispensed only from … certified opioid treatment programs (OTPs), creating access barriers in rural counties with a shortage of facilities," study authors from the Yale School of Medicine said.

For their analysis, researchers measured how far patients would have to travel to access a methadone clinic in nearly 500 counties in Indiana, Kentucky, Ohio, Virginia, and West Virginia – states that have been hit hard by the opioid crisis. On average, methadone patients would need to drive about 37 minutes to the nearest opioid treatment program, though travel times ranged from about eight minutes in the most urban areas to 49 minutes in the most rural areas, according to the study, published Tuesday in JAMA.

By contrast, people on average were only about 16 minutes away from their nearest federally qualified health center – facilities in underserved areas that provided health care services to more than 28 million patients last year – and about 15 minutes from a dialysis center. Similarly to methadone, dialysis patients must visit centers in person multiple times per week to receive treatment.

"If methadone prescribing were integrated into (federally qualified health centers) then these long average drive times to methadone in rural counties could be reduced," says Dr. Paul Joudrey, the study's lead author and a postdoctoral fellow at the Yale School of Medicine.

Administering methadone in primary care settings is standard practice in countries like Australia and Canada, the study notes. Methadone also is the most commonly prescribed medication to treat opioid use disorder in those countries, according to a piece published last year in the New England Journal of Medicine.

The new research highlights "how rural communities could benefit if the United States moved its methadone policy in the direction of these other countries," Joudrey says.


Expanding Medicaid Expands Opioid Treatment Access ]

Yet distance isn't the only barrier to bridging the treatment gap: Some worry about diversion and misuse of the drug, and not all state Medicaid programs cover methadone.

Meanwhile, buprenorphine can be prescribed and taken at home as a pill, while naltrexone can be taken either as a pill or an extended-release injection. Both buprenorphine and naltrexone are covered by Medicaid in all states.

Despite the longer travel time in rural areas, Joudrey also notes that patients in urban areas can struggle to access treatment for opioid addiction.

"Our drive time estimates in urban counties did not take into account public transportation," Joudrey says. "And just because drive times are short in urban counties does not mean everyone can get methadone who wants it. There may be other unique barriers in urban counties, such as waitlists."

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