![[ Visit Client Website ]](images/banner.gif)
In 2019, 70.6% of drug overdoses were opioid-related. Adequate access to opioid use disorder (OUD) treatment is critical in addressing opioid-related mortality. OUD is effectively treated with medications for OUD (MOUDs). Currently, there are three FDA approved MOUDs — methadone, buprenorphine, and naltrexone. Naltrexone, an opioid antagonist, has poor adherence that has limited its effectiveness. Methadone, an agonist and buprenorphine, a partial agonist, are equally effective in treating OUD, but methadone is available in highly regulated SAMHSA-certified opioid treatment programs (OTPs). Buprenorphine can be prescribed in a physician’s office, but barriers to buprenorphine persists despite creation of a waiver program allowing non-physician providers to prescribe buprenorphine. 40% of U.S. counties lack a single waivered provider. Further, disparities in buprenorphine treatment by race and socio-economic status exists. Little is known about the geographic distribution of buprenorphine providers in local communities and availability of providers by communities’ socio-economic status. The objective of this study was to examine the: 1) geographic distribution of buprenorphine providers and 2) association between community socio-economic characteristics and buprenorphine providers in the continental U.S.
Methods
This observational study examined community characteristics associated with access to buprenorphine providers at the zip-code tabulation area (ZCTA) level using logistic regression. Data on buprenorphine providers was extracted from SAMHSA’s facilities locator website. Community characteristics were extracted from the American Community Survey (ACS) 5-year estimates (2015-2019). Rurality was defined using the USDA Rural-Urban Commuting Area Codes. The analytic sample included 30,367 ZCTAs. The outcome, availability of buprenorphine provider, was dichotomized (yes/no). Main variables included median income, racial/ethnic composition, and rurality. Covariates were % with less than a high-school diploma, unemployment rate, and health coverage rate.
Results
A total of 50,652 buprenorphine providers were identified in 9,692 (31%) ZCTAs. Of 9,692 ZCTAs, 6,702 (69%) had more than one provider and 2,990 (31%) had only one. A lower proportion of communities in the lowest median income quartile had a buprenorphine provider compared to the highest [2,053 (21%) versus 3,452 (36%)]. After adjusting for covariates, the odds of having a buprenorphine provider increased by 6% with every $20,000 increase in median income [AOR 1.06; (95% CI: 1.03-1.09)]. A lower proportion of rural communities had buprenorphine providers compared to urban [2,141 (16%) versus 7,551 (44%)]. After adjusting for covariates, the odds of having a buprenorphine provider in a rural ZCTA was 63% less than an urban ZCTA [AOR 0.37; (95% CI: 0.35-0.40)]. Lower level of education was associated with a lower availability of providers; with every 5% increase in less than high-school education attainment, the odds of having a provider decreased by 20% [AOR 0.80; (95% C.I: 0.79-0.82)]. With every 2% increase in health coverage rates, the odds of having a provider increased by 6% [AOR 1.07; (95% CI: 1.05-1.08)].
Conclusion
Rural-urban differences exist in buprenorphine provider availability. Further, a community’s lower socio-economic status is a barrier in access to buprenorphine treatment. Policies are needed to expand the availability of waivered providers in rural and lower socio-economic status communities.