Longer Drive Times to Opioid Treatment Programs May Limit Methadone Access in United States

Population-weighted driving times in the United States are longer to opioid treatment programs than to pharmacies, which may restrict access to methadone treatment, according to study results published in JAMA Psychiatry.

In the United States, methadone treatment is restricted to opioid treatment programs. However, patients may have better access to pharmacies than opioid treatment programs. Using data from the 2010 United States Census, Robert A. Kleinman, MD, from the Stanford University School of Medicine in Stanford, California, aimed to compare American driving access to opioid treatment programs and pharmacies.

Census tracts in all 50 states and the District of Columbia were included for which the mean center of the population was within 3 miles of a road network and within 12 hours of both an opioid treatment program and a pharmacy. The driving times were also analyzed by county and county type.

A total of 1682 unique opioid treatment program locations and 69,475 unique pharmacy locations were identified. Of the 73,057 consensus tracts in the United States and the District of Columbia, 72,443 met inclusion criteria. The mean population-weight drive times were 20.4 minutes (95% CI, 20.3-20.6 minutes) to the nearest opioid treatment program and 4.5 minutes (95% CI, 4.4-4.5 minutes; P <.001) to the nearest pharmacy.

The majority of US residents (98%) lived in census tracts with a shorter drive time to the nearest pharmacy than the nearest opioid treatment program. A total of 17.8% of residents had a drive time greater than or equal to 30 minutes to the nearest opioid treatment program compared with 0.4% who had a drive time greater than or equal to 30 minutes to the nearest pharmacy.

Clusters of counties in the mountain region (Montana, Idaho, Wyoming, Nevada, Utah, Colorado, Arizona, and New Mexico) and the Midwest (North Dakota, South Dakota, Nebraska, and Kansas) had notably higher drive times to opioid treatment programs (≥120 mins). There were no opioid treatment programs identified in Wyoming.

The population-weighted mean driving time was longer to opioid treatment programs than to pharmacies within all urban-rural county classifications. However, considerable variability was found by county classification in the mean driving time to opioid treatment programs and to pharmacies (P <.001 for both). Driving times to both opioid treatment programs and pharmacies were longer in nonmetropolitan counties than in metropolitan counties, and the difference in driving time was highest for nonmetropolitan counties.

Similar results were observed with regard to driving distances and costs.

Dr Kleinman noted that not all opioid treatment programs included in the analysis dispense methadone, and that evidence from the United Kingdom and Australia suggests that not all community pharmacies would dispense methadone either, suggesting that actual and theoretical drive times to methadone treatment may be underestimated.

Other study limitations include potential changes in population distribution since 2010 and the use of driving use estimates derived from the 2010 United States Census rather than from individual residences of those eligible for methadone treatment. Driving access to other FDA-approved opioid use disorder treatments, like buprenorphine, was not assessed.

“Benefits of in-person administration of methadone at [opioid treatment programs] should be balanced with the low feasibility of commutes in many rural regions of the US,” Dr Kleinman concluded. “Pilot studies may help determine whether pharmacy-based dispensing of methadone maintenance treatment for [opioid use disorder] is effective, safe, and feasible in the US.”

Reference

Kleinman RA. Comparison of driving times to opioid treatment programs and pharmacies in the US. Published online July 15, 2020. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2020.1624