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Assessment of Community-Level Vulnerability and Access to Medications for Opioid Use Disorder

IMPORTANCE: Given that COVID-19 and recent natural disasters exacerbated the shortage of medication for opioid use disorder (MOUD) services and were associated with increased opioid overdose mortality, it is important to examine how a community’s ability to respond to natural disasters and infectiou...

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Autores principales: Joudrey, Paul J., Kolak, Marynia, Lin, Qinyun, Paykin, Susan, Anguiano, Vidal, Wang, Emily A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9020217/
https://www.ncbi.nlm.nih.gov/pubmed/35438757
http://dx.doi.org/10.1001/jamanetworkopen.2022.7028
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author Joudrey, Paul J.
Kolak, Marynia
Lin, Qinyun
Paykin, Susan
Anguiano, Vidal
Wang, Emily A.
author_facet Joudrey, Paul J.
Kolak, Marynia
Lin, Qinyun
Paykin, Susan
Anguiano, Vidal
Wang, Emily A.
author_sort Joudrey, Paul J.
collection PubMed
description IMPORTANCE: Given that COVID-19 and recent natural disasters exacerbated the shortage of medication for opioid use disorder (MOUD) services and were associated with increased opioid overdose mortality, it is important to examine how a community’s ability to respond to natural disasters and infectious disease outbreaks is associated with MOUD access. OBJECTIVE: To examine the association of community vulnerability to disasters and pandemics with geographic access to each of the 3 MOUDs and whether this association differs by urban, suburban, or rural classification. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of zip code tabulation areas (ZCTAs) in the continental United States excluding Washington, DC, conducted a geospatial analysis of 2020 treatment location data. EXPOSURES: Social vulnerability index (US Centers for Disease Control and Prevention measure of vulnerability to disasters or pandemics). MAIN OUTCOMES AND MEASURES: Drive time in minutes from the population-weighted center of the ZCTA to the ZCTA of the nearest treatment location for each treatment type (buprenorphine, methadone, and extended-release naltrexone). RESULTS: Among 32 604 ZCTAs within the continental US, 170 within Washington, DC, and 20 without an urban-rural classification were excluded, resulting in a final sample of 32 434 ZCTAs. Greater social vulnerability was correlated with longer drive times for methadone (correlation, 0.10; 95% CI, 0.09 to 0.11), but it was not correlated with access to other MOUDs. Among rural ZCTAs, increasing social vulnerability was correlated with shorter drive times to buprenorphine (correlation, –0.10; 95% CI, –0.12 to –0.08) but vulnerability was not correlated with other measures of access. Among suburban ZCTAs, greater vulnerability was correlated with both longer drive times to methadone (correlation, 0.22; 95% CI, 0.20 to 0.24) and extended-release naltrexone (correlation, 0.15; 95% CI, 0.13 to 0.17). CONCLUSIONS AND RELEVANCE: In this study, communities with greater vulnerability did not have greater geographic access to MOUD, and the mismatch between vulnerability and medication access was greatest in suburban communities. Rural communities had poor geographic access regardless of vulnerability status. Future disaster preparedness planning should match the location of services to communities with greater vulnerability to prevent inequities in overdose deaths.
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spelling pubmed-90202172022-05-02 Assessment of Community-Level Vulnerability and Access to Medications for Opioid Use Disorder Joudrey, Paul J. Kolak, Marynia Lin, Qinyun Paykin, Susan Anguiano, Vidal Wang, Emily A. JAMA Netw Open Original Investigation IMPORTANCE: Given that COVID-19 and recent natural disasters exacerbated the shortage of medication for opioid use disorder (MOUD) services and were associated with increased opioid overdose mortality, it is important to examine how a community’s ability to respond to natural disasters and infectious disease outbreaks is associated with MOUD access. OBJECTIVE: To examine the association of community vulnerability to disasters and pandemics with geographic access to each of the 3 MOUDs and whether this association differs by urban, suburban, or rural classification. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of zip code tabulation areas (ZCTAs) in the continental United States excluding Washington, DC, conducted a geospatial analysis of 2020 treatment location data. EXPOSURES: Social vulnerability index (US Centers for Disease Control and Prevention measure of vulnerability to disasters or pandemics). MAIN OUTCOMES AND MEASURES: Drive time in minutes from the population-weighted center of the ZCTA to the ZCTA of the nearest treatment location for each treatment type (buprenorphine, methadone, and extended-release naltrexone). RESULTS: Among 32 604 ZCTAs within the continental US, 170 within Washington, DC, and 20 without an urban-rural classification were excluded, resulting in a final sample of 32 434 ZCTAs. Greater social vulnerability was correlated with longer drive times for methadone (correlation, 0.10; 95% CI, 0.09 to 0.11), but it was not correlated with access to other MOUDs. Among rural ZCTAs, increasing social vulnerability was correlated with shorter drive times to buprenorphine (correlation, –0.10; 95% CI, –0.12 to –0.08) but vulnerability was not correlated with other measures of access. Among suburban ZCTAs, greater vulnerability was correlated with both longer drive times to methadone (correlation, 0.22; 95% CI, 0.20 to 0.24) and extended-release naltrexone (correlation, 0.15; 95% CI, 0.13 to 0.17). CONCLUSIONS AND RELEVANCE: In this study, communities with greater vulnerability did not have greater geographic access to MOUD, and the mismatch between vulnerability and medication access was greatest in suburban communities. Rural communities had poor geographic access regardless of vulnerability status. Future disaster preparedness planning should match the location of services to communities with greater vulnerability to prevent inequities in overdose deaths. American Medical Association 2022-04-19 /pmc/articles/PMC9020217/ /pubmed/35438757 http://dx.doi.org/10.1001/jamanetworkopen.2022.7028 Text en Copyright 2022 Joudrey PJ et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Joudrey, Paul J.
Kolak, Marynia
Lin, Qinyun
Paykin, Susan
Anguiano, Vidal
Wang, Emily A.
Assessment of Community-Level Vulnerability and Access to Medications for Opioid Use Disorder
title Assessment of Community-Level Vulnerability and Access to Medications for Opioid Use Disorder
title_full Assessment of Community-Level Vulnerability and Access to Medications for Opioid Use Disorder
title_fullStr Assessment of Community-Level Vulnerability and Access to Medications for Opioid Use Disorder
title_full_unstemmed Assessment of Community-Level Vulnerability and Access to Medications for Opioid Use Disorder
title_short Assessment of Community-Level Vulnerability and Access to Medications for Opioid Use Disorder
title_sort assessment of community-level vulnerability and access to medications for opioid use disorder
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9020217/
https://www.ncbi.nlm.nih.gov/pubmed/35438757
http://dx.doi.org/10.1001/jamanetworkopen.2022.7028
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