Medication Assisted Treatment Density and Alcohol Sales' Relationship to Opioid-Related Deaths

Introduction/Background

The current opioid epidemic continues to impact communities across the United States (US). Opioid-related overdoses and deaths are either on the rise or being sustained at a high level in many communities, with drug overdose deaths becoming the top cause of US accidental deaths in 2014.

Participating in Medication Assisted Therapy (MAT) has been shown to reduce the risk of opioid-related deaths after an overdose; however, the participation rate in MAT is low among those with an opioid use disorder. This may be due to both the stigma surrounding MAT and the lack of available treatment facilities. The ability to access a MAT program is an important avenue through which opioid-related harms may be reduced.

The use alcohol and opioids at the same time is a dangerous combination that serves to increase the risk of an overdose and limits respiratory and coronary function. Using alcohol while enrolled in MAT has been shown to reduce the time spent in treatment. Research in this area has mainly focused on the individual impact of alcohol on opioid-related outcomes. This study considered the impact of alcohol sales and MAT treatment availability on rates of opioid-related deaths at a community level.

Methods

This ecological analysis focused on New Hampshire (NH), which had the second highest rate of both substance related deaths in 2015 and substance use disorders in 2014 in the United States. Data were combined from several sources to investigate whether community alcohol sales and MAT treatment density were associated with drug related deaths in 2017. Data were combined from three sources: 1.) National Alcohol Beverage Control Association provided information on the location and volume sold of alcohol retailers; 2.) NH Division of Vital Records provided the number of opioid-related deaths and 3) NH Bureau of Drug and Alcohol Services provided a listing of MAT service facilities. Per capita alcohol sales volume, rates of opioid-related deaths, and MAT density measures were calculated at the zip code level (due to privacy concerns, zip code was the lowest level of aggregation available).

Results

Alcohol sales volume was 13.7 liters per person over 14, there were .18 MAT facilities per 1,000 residents, and the rate of death related to opioids was 34 per 100,000. Findings suggest both alcohol sales volume (β=.79, p<.01) and available MAT (β=.43, p<.05) were associated with increased rates of opioid-related deaths.

Conclusion/Implications

The high rate of opioid-related harms in the US call for effective delivery of substance abuse treatment and innovative policies to reduce those harms. Findings here indicate MAT services were associated with higher rates of opioid-related deaths. While surprising, some evidence suggests substance use treatment is concentrated in areas of high drug market activity. Additionally, a greater volume of alcohol sold was associated with higher mortality. Policy responses could leverage alcohol control policy as an early warning system for opioid-related overdoses if the relationship between alcohol and mortality was supported through future time series designs.