Factors Associated with Perceived Transportation Barriers for Access to Opioid Prevention, Treatment, and Recovery Services

Background and Purpose: Millions of Americans suffer from pain and are often prescribed opioids to treat their conditions. The opioid epidemic has become a significant public health crisis since it was first declared as a national public health emergency in 2017. Alabama had the highest opioid prescription fill rates in 2018. Opioid overdose deaths have become a growing concern in Alabama, increasing by 118% between 2015 and 2020. The Black community experiences even more complex drug-related challenges. While fear and mistrust stem from historical trauma, transportation barriers impede widespread acceptance of substance use treatment programs, including harm reduction models such as opioid replacement therapy. The Black Belt region is characterized by high poverty rates and limited access to healthcare services. Research suggests that transportation barriers can contribute to healthcare underutilization, which would lead to a range of health problems, including opioid misuse. We aim to examine factors associated with transportation barriers inhibiting access to opioid treatment programs in rural Alabama.

Methods: We used a questionnaire as the primary data collection tool and recruited a convenience sample (N=191) of African Americans who were 18 years and older living in three Black Belt communities. Perceived transportation barriers for access to opioid treatment service was claimed as the dependent variable to estimate health service use challenges. The coded outcomes have incremental values from 0=never to 4=always. The higher score indicates more perceived transportation barriers for access to the services. Drawing on the Andersen model, we fitted a multiple regression model using a linear combination of factors: predisposing, enabling, and need.

Results: Participants reported a medium level of perceived transportation barriers for access to opioid treatment services on average. Most participants were female, and survey respondents reported high levels of positive attitudes toward opioid-related needs in their community. They had little knowledge about state opioid policy and programs and reported a moderate level of social isolation. The weighted sum of Andersen’s model variables was significantly related to the outcome. Importantly, personal attitude toward opioid-related needs was positively associated with the outcome, indicating participants who had more positive attitudes felt more transportation barriers. Regarding enabling factors, participants who had more advanced knowledge of state opioid policy and programs felt more transportation barriers; those who were less socially isolated felt they were likely to face fewer barriers.

Conclusions and Implications: We found that individuals with more positive attitudes toward opioid-related needs and a better understanding of the state’s opioid policy/programs and who were more socially isolated faced increased transportation barriers for access to services. This subset population would be potential clients who need targeted assistance; yet experience limited access to transportation for treatment, which might make treatment more inequitable–thus negatively impacting their health outcomes. Social workers can help fight opioid use disorders by providing culturally responsive case management. To address lingering community health problems during the opioid crisis, interprofessional collaborative practice models that incorporate social workers should be developed and implemented to reduce the service gap due to transportation hurdles.