Dora Guo

The nearest opioid treatment center can be located almost an hour away in rural counties that have  some of the highest overdose rates in the United States.

In a study published in the Journal of the American Medical Association on Oct. 1, Yale researchers showed that travel time to the closest opioid treatment programs, or OTPs,  were longer for individuals in rural counties. The authors suggested that this travel time could be reduced if federally qualified health centers — community-based, federally-funded health care providers in underserved regions, often abbreviated to FQHCs — could dispense methadone.

“What this study shows is that rural communities face disproportionately long drive times to access methadone for opioid use disorder,” said first author Paul Joudrey, a postdoctoral fellow at the Yale School of Medicine. “These long drive times in rural communities could be reduced if methadone prescribing occurred in federally qualified health centers.”

The study considered drive times to the nearest OTPs and FQHCs in Indiana, Kentucky, Ohio, Virginia and West Virginia. These five states have the highest county rates of opioid-related overdose mortality in the U.S. Currently, only OTPs can provide methadone for opioid-use disorder, but the researchers wanted to consider how drive times to treatment would be impacted if FQHCs were also permitted to dispense methadone for opioid-use disorder.

Across all counties, the mean drive time to an OTP was 37.3 minutes. The longest drive time to an OTP was 49.1 minutes for the most rural counties, while the shortest was 7.8 minutes in counties classified as large central metro areas.

Yet, the researchers determined that the mean drive time to FQHCs across all counties was 15.8 minutes — a 21.5-minute decrease from the average drive time to the nearest OTP. And for the most rural counties, the drive time to a FQHC was 17.3 minutes — a reduction of more than 30 minutes compared to the drive time to an OTP.

Currently, the U.S. Substance Abuse and Mental Health Services Administration must certify OTPs to dispense methadone. Because of this, primary care centers and pharmacies cannot dispense methadone under U.S law.

Other countries, including Canada and Australia, allow primary care centers and pharmacies to provide access to methadone, according to Joudrey. He said that much of the current U.S policy regulating methadone prescriptions originated during the Nixon administration when methadone was still a relatively new treatment and has since not been significantly updated.

Though other treatment options for opioid-use disorders, such as suboxone or naltrexone, can be prescribed in primary care settings, Joudrey said that individuals have different responses to these treatments, and therefore all patients should have access to various treatment options.

Joudrey compared treatment of opioid-use disorder to treating other diseases. “We would never accept, if you lived in a rural community, that there would only be one medication available for diabetes or one medication available for high blood pressure just because you lived in a rural community,” he said.

Joudrey emphasized that the team’s findings underscore the difficulty of accessing treatment in rural areas, not the ease of receiving treatment in urban areas.

“Just because we found that there were short drive times in urban counties, that doesn’t mean that methadone is easy to access in those communities. It just means that drive time is probably not the barrier,” said Joudrey.

A potential solution would follow Canada and Australia’s model and allow pharmacies to dispense methadone as a treatment for opioid-use disorder. Future research could focus on how drive times to the nearest pharmacy would compare to the team’s findings about drive times to OTPs and FQHCs.

Growing up in Mansfield, Ohio, a rural area impacted by the opioid epidemic, Joudrey said he has personally seen the barriers to treatment for opioid-use disorders in rural and urban communities. He completed part of his medical training at a methadone clinic in the South Bronx, where his patients would also tell him how far they had to travel to access methadone.

Travelling, long waitlists and challenges with public transportation can all impact individuals’ ability to receive the most effective treatment. Joudrey noted that more widely available methadone in surrounding areas could limit the stress on facilities in cities like New Haven, which often treat not only city residents but also those who have no options closer to home.

“We need more people to understand that methadone is a drug that is used to treat opioid addiction, and it can be really helpful for people,” said Joudrey. “We need to make it more available so that people can access it when they need it.”

In the U.S., methadone’s properties were first described in 1947.

 

Katie Taylor | katie.taylor@yale.edu