(Withdrawn) Historic Redlining, Segregation, and Recovery Service Accessibility in Philadelphia

Background and Purpose: The number of fatal overdoses from opioids in Philadelphia rose from 211 in 2003 to 1,074 in 2017, and most recently to 1,044 in 2020. Redlining, a practice used by the New Deal era Home Owners’ Loan Corporation (HOLC), to determine which neighborhoods in cities with populations greater than 40,000 were worthy of investment, may have influenced economic and racial segregation that persists in urban America today.

Methods: This research involved public data from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) buprenorphine Treatment Practitioner Locator. The point data was merged with data from the SAMHSA directory of Opioid Treatment Programs (OTPs) in Philadelphia. The postal addresses of the buprenorphine and methadone OUD treatment providers were then geocoded in ArcGIS using the ESRI World Locator and plotted against digitized maps from the HOLC archives. This study explored how racialized redlining from 1937 affected OUD treatment accessibility in Philadelphia in 2022 using GIS mapping techniques and basic inferential statistics. It was hypothesized that “negative” or neutral HOLC grades would result in the absence of methadone treatment facilities in historically White enclaves; furthermore, due to the lack of stigma associated with primary care providers becoming x-waivered, there would be no effect of redlining on the distribution of buprenorphine providers across these districts.

Results: Visual inspection of the map of services alone indicated that there are no OTPs present in historically White communities, per the HOLC grading system. A count of clinics revealed no OTPs in neighborhoods graded “Best” investments, and only two OTPs in the neighborhoods graded “Still Desirable”. The remaining 17 methadone clinics are located in geographies that received grades of “Definitely in Decline”, “Hazardous”, or were ungraded in 1937. Regarding buprenorphine providers, services tended to be relatively well-distributed across traditionally White neighborhoods. Hypothesis number one was supported by Fisher's Exact Test, which indicated a significant association between HOLC grade and methadone treatment availability (p < 0.01). Surprisingly, regarding hypothesis two, a chi-square test of independence indicated a nonequivalent distribution of services across HOLC grades, such that buprenorphine providers were overrepresented in "Hazardous" and ungraded HOLC regions; x² (4, N = 458) = 322.89, p < 0.01.

Conclusions and Implications: Interestingly, both methadone and buprenorphine services were overrepresented in "negative" and ungraded HOLC zones. Redlining in 1937 resulted in program placement in economically disadvantaged neighborhoods, which may impede access to services. These policies were rooted in a legacy of systematic racism and exclusion against Black, Brown, and immigrant communities in the U.S.. Policymakers and advocates alike must be aware of the racialized nature of NIMBY-style grassroots activism that emerged in response to the establishment of new services for consumers of OUD treatments. Whether the treatment involves buprenorphine or methadone, no one should be forced to struggle to access treatment for OUDs based on their place of residence. Indeed, when public health is protected from the influence of NIMBY-style politics, everyone benefits.