Healthy Regions + Policies Lab

During the COVID-19 pandemic, the disruption and shortage of treatment options for people with opioid use disorder (OUD) has been linked to significantly higher rates of overdose deaths across the country. How might an improved understanding of current community-level availability of medications for opioid use disorder (MOUD) inform future responses to pandemics or natural disasters to minimize disruption?

New research published in the journal JAMA Network Open found that a community’s geographic access to MOUD does not always match its vulnerability to disasters — meaning some areas with greater vulnerability are even less likely to have better geographic access to MOUD. 

Led by Dr. Paul Jourdrey at the Yale University Program in Addiction Medicine and Dr. Emily Wang at the SEICHE Center for Health and Justice, and co-authored by Marynia Kolak, Qinyun Lin, Susan Paykin, and Vidal Aguilano Jr. at the Healthy Regions & Policies Lab, the research looks at whether the availability of MOUD treatment in a community was in line with that community’s social vulnerability. 

The researchers found that a community’s access to medication services was not always matched with its social vulnerability.

Natural Disasters Can Disrupt Access

Some background: Evidence suggests that COVID-19 and other recent natural disasters such as hurricanes and major storms have exacerbated the shortage of MOUD services and were associated with increased opioid overdose and death rates.  There are currently three FDA-approved medications to treat opioid use disorder: buprenorphine, methadone, and extended-release naltrexone. Given the differences in pharmacology, delivery, and patient preferences, the three MOUDs should be accessible to all communities to facilitate treatment individualization and maximized retention. This is especially important during natural disasters, when critical services are particularly vulnerable. 

Social vulnerability refers to the potential negative effects on communities caused by external stresses on human health, including disease outbreaks or natural- or human-caused disasters. In this analysis we used CDC’s Social Vulnerability Index at the ZIP code level to measure community-level vulnerability. 

Measuring Geographic Access Across Rural, Suburban, Urban Communities

We used a pre-computed and validated road network travel matrix from OSRM to calculate a measure of geographic access for all US ZIP codes. We calculated a) driving time to the nearest ZIP code with an MOUD provider, stratified by type (buprenorphine, methadone, or extended-release naltrexone), and b) count or number of providers by type within a 30 minute driving time range, a widely-accepted proxy in public health literature for “good” access. We then stratified data across rural, suburban, and urban communities by their ZIP codes. 

We found that the association between low access and high vulnerability was greatest in suburban communities. Furthermore, because rural areas had essentially universally poor access to MOUD (defined in the analysis as more than a 30 minute drive away), there was no association between vulnerability and access to medications. 

Drive time represents the time in minutes from the population weighted center of the zip code tabulation area to the zip code tabulation area of the nearest treatment location for each treatment type. Count within 30 minutes represents the number of treatment locations within a 30-minute drive of a zip code tabulation area. Unpopulated large land areas, such as national parks or large water bodies, are not assigned to a ZCTA, and these gaps are shown in white.

Reducing Inequities in MOUD Access

These findings have important implications for research and policy. Disaster preparedness planning should match the location of services to communities with greater vulnerability to prevent inequities in overdose deaths and other OUD-related harms. Furthemore, more long-term, flexible regulations over MOUD provision, particularly methadone (currently the most restricted access), may be required if inequities in disaster preparedness are to be mitigated. 

Read more about the research methods, results, and conclusions in Assessment of community-level vulnerability and access to medications for opioid use disorder” in JAMA Network Open

Article Citation:

Joudrey PJ, Kolak M, Lin Q, Paykin S, Anguiano V, Wang EA. Assessment of Community-Level Vulnerability and Access to Medications for Opioid Use Disorder. JAMA Netw Open. 2022;5(4):e227028. doi:10.1001/jamanetworkopen.2022.7028

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