Critical access medication for opioid use disorder (MOUD) treatment facilities in the continental United States

RESEARCH OBJECTIVE: Medication opioid use disorder (MOUD) treatment is the first-line approach to the treatment of opioid use disorder (OUD). This analysis seeks to identify “critical access” MOUD facilities that ensure geographic access for MOUD patients. Using public-source data and spatial analysis, we identify the top 100 “critical access” MOUD units across the continental U.S. STUDY DESIGN: We use locational data from SAMHSA's Behavioral Health Treatment Services Locator and DATA 2000 waiver buprenorphine providers. We identify the closest MOUDs to each ZIP Code Tabulation Area (ZCTA)’s geographic centroid. We then construct a difference-in-distance metric by computing the difference in this distance measure between closest and second-closest MOUD, multiplied by ZCTA population, ranking MOUDs by difference-distance scores. POPULATION STUDIED: All listed MOUD treatment facilities and all listed ZCTA's across the continental U.S., and all listed MOUD providers proximate to these areas. PRINCIPAL FINDINGS: We identified the top 100 critical access MOUD units in the continental United States. Many critical providers were in rural areas in the central United States, as well as a band extending east from Texas to Georgia. Twenty-three of the top 100 critical access providers were identified as providing naltrexone. Seventy-seven were identified as providing buprenorphine. Three were identified as providing methadone. CONCLUSIONS: Significant areas of the United States are dependent on a single critical access MOUD provider. IMPLICATIONS FOR POLICY OR PRACTICE: Place-based supports may be warranted to support MOUD treatment access in areas dependent upon critical access providers.