Among all race/ethnic groups in the US, American Indian/Alaska Native and Black populations have the highest rates of opioid overdose death. These disparities may be due to differences in access to treatment generally, and opioid use disorder medications specifically. This study examined differences in geographic proximity to opioid treatment programs and buprenorphine providers by race and ethnicity.
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There has been an increase in racial disparities in opioid-involved overdose deaths with American Indian/Alaska Native and Black populations now having the highest rates of opioid overdose deaths of any race/ethnicity in the US. It is unclear why these groups have experienced a surge in opioid overdose deaths. One possible explanation for these findings is differences in opioid treatment program access. Prior to 2023, physicians could not prescribe medications to treat opioid use disorder (e.g., buprenorphine) without first receiving additional training and a waiver from the government. Such restrictions may have further burdened providers serving these communities which experience higher rates of poverty and marginalization than other groups, resulting in Native American/Black populations having to travel further to access treatment. This barrier could result in lower rates of opioid use disorder medication initiation and sustained engagement over time. To date, however, no studies have examined potential differences in geographic location between racial/ethnic groups. The present research offers insights on how the racial/ethnic characteristics of neighborhoods are associated with geographic distance to opioid treatment programs and buprenorphine providers in the US.
This study used an ecological cross-sectional design- publicly available data from multiple sources were merged to conduct secondary data analysis including 2019 US census tract data used to assess neighborhood characteristics. The study was conducted at the census block level (600-3000 people), resulting in 215,189 block groups. The authors excluded blocks from Alaska and Hawaii because >50 % of land area in Alaska and 10% of land area in Hawaii is not accessible by a road network. Therefore, road distance could not be computed for all block groups in these states. The study also excluded block groups with no population. Regional overdose deaths data were culled from The Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research. The location of opioid treatment programs and buprenorphine providers was derived from the Substance Abuse and Mental Health Services Administration.
The focus of this study was to examine geographic disparities in access to opioid treatment programs and buprenorphine providers by race and ethnicity, neighborhood deprivation, and rurality across the US. Using 2019 Census data the authors categorized block groups based on self-reported predominant racial/ethnic identity of residents. Predominant majority blocks consisted of blocks in which >50% of residents identified with one of racial/ethnic categories adapted from the U.S. Census: American Indian/Alaska Native, Asian, Black, White, Hispanic (regardless of racial identity), or no single racial majority. Block groups where no racial/ethnic identity was endorsed by most of the population were categorized as “no single racial majority”. The authors calculated the percentage of each race/ethnicity residing in census blocks as well. National overdose mortality data from 2019 were used to calculate mortality burden of blocks (e.g., higher, or lower than the national average). The Area Deprivation Index was also used to quantify the economic disadvantage of census blocks, a composite index aggregating factors such as employment, income, and housing. The rurality of census blocks was measured via Rural-Urban Commuting Area codes– a measurement system created by the US Department of Agriculture which measures population density, urbanization, and daily commuting of residents.
The primary outcome of the study was road network distance in miles between a census block group and the nearest opioid treatment program/buprenorphine provider. To measure this the authors geocoded the locations of 1643 opioid treatment providers – which dispense and oversee methadone for opioid use disorder in the US – and 37,692 buprenorphine providers. Next distances between blocks and treatment facilities were calculated using the road network dataset of North America (available on the Environmental Systems Research Institute ArcGIS software).
The researchers utilized statistical modeling to determine the association between racial/ethnic characteristics of census blocks and distance to the nearest source of opioid treatment. These models controlled for overdose cases, economic disadvantage, and rurality of blocks to isolate the effect of race/ethnicity. The authors also identified clusters of block groups with varying patterns of access to opioid treatment. Three patterns emerged from these analyses: clusters of block groups with shorter distances to opioid treatment providers (“hot spots”); block clusters with longer distances to opioid treatment programs (“cold spots”); and clusters which were neither classified as either hot or cold (“neutral zones”).
Analyses revealed that the median road distance between blocks and opioid treatment programs and buprenorphine providers was 8 miles (range 3-20) and 2 miles (range 1-5) respectively. Most of the blocks sampled had a majority White population (62.3%) followed by Hispanic (10.2%), no single race majority (11.5%), Black (8.8%), Asian (1.0%) and American Indian/Alaska Native (.2%). Most census blocks were classified as being in metropolitan areas (80.6%) with the remainder being suburban (13.6%) or rural areas (5.8%). Most census blocks were categorized as not being economically disadvantaged (69.4%). Census blocks were evenly split in terms of overdose deaths; 53.5% reported fewer overdose deaths than the national average, while 42.7% reported more (the remaining blocks had unknown rates of overdose deaths [3.8%]).
American Indian/Alaska Native people were the furthest, while other people of color were the closest
The median distance between majority American Indian/Alaska Native census blocks and the nearest opioid treatment program and buprenorphine providers was 88 and 17 miles, respectively. Statistical models showed that relative to White majority blocks, census blocks that were majority American Indian/Alaska Native were about 35.9 and 9.6 miles further from the nearest opioid treatment program and buprenorphine providers than White people respectively. In contrast, census blocks where other people of color lived were closer to such programs than White people. For example, majority Black blocks were about 5.5 miles closer to opioid treatment programs than White majority blocks.
Rural and economically disadvantaged census blocks were further than less disadvantaged areas
Areas designated as more economically disadvantaged were about 11.3 miles and 2.6 miles from the nearest opioid treatment programs and provider respectively. Census blocks that were less disadvantaged were about 6.9 and 1.9 miles from the nearest opioid treatment programs and provider respectively. Those living in areas designated as small town/rural had to travel 35 and 10 miles further to reach opioid treatment programs and opioid treatment providers respectively compared to metropolitan block groups.
Travel distance was greatest for American Indian/Alaska Native residents in rural, economically disadvantaged areas
In more disadvantaged block groups that contained 25% American Indian/Alaska Native residents, the average travel distance was 59 miles, while in block groups with 75% American Indian/Alaska Native residents, the distance was 84 miles. In small town/rural block groups with 25% American Indian/Alaska Native people, the mean distance to the nearest OTPs was 73 miles compared to 99 miles when 75% of block group residents were American Indian/Alaska Native.
The results of this study suggest that disparities in proximity to opioid treatment exist between race/ethnic, rural, and social class groups in the US. Residents of majority American Indian/Alaska Native census block groups (e.g., those living on reservations) were about 88 and 17 miles from the nearest opioid treatment program and buprenorphine provider, respectively. This is in stark contrast to other majority census block groups which were only about 4 to 10 miles from opioid treatment programs and buprenorphine providers respectively. They also found that the rurality and economic disadvantage of census blocks was associated with travel distance to opioid treatment. Those living in areas rural areas had to travel 35 and 10 miles further to reach opioid treatment programs and opioid treatment providers respectively compared to those living in cities/suburbs. Additionally, the researchers found that the economic disadvantage of a census block was associated with travel distance to opioid use disorder medication providers. Census blocks with more economic disadvantage were about 4 miles and 1.3 miles further from opioid treatment programs and providers respectively than less disadvantaged blocks. The researchers also found that people of color lived closer to sources of opioid medication than White Americans. For instance, Black census block residents lived 5.5 and 2 miles closer to opioid treatment programs and buprenorphine providers respectively than White residents. This finding cannot be explained purely by urban vs. rural location given that models controlled statistically for each block’s rural-urban profile.
These results suggest that physical distance from the opioid use disorder medications methadone and buprenorphine may serve as a barrier for American Indian/Alaska Native residents from receiving care. This may be due to the fact that the number of substance use disorder clinics run by Tribal governments or the Indian Health Service (IHS), a part of the US Department of Health and Human Services, providers remains disproportionately low compared to private clinics. This disparity may be due to underfunding of the IHS. Such underfunding causes delays in treatment which could exacerbate health issues. Therefore, it is possible that increasing funding for IHS may improve treatment access for American Indian/Alaska Native populations. Telemedicine visits for opioid use disorder may also help address these disparities; early studies suggest online video platforms can help increase treatment retention. Of note, the DEA extended regulatory permission to prescribe controlled substances – including opioid use disorder medications like buprenorphine – through the end of 2024. Access to these digital approaches depend of course on access to broadband internet, which may also pose a barrier for those in more remote, economically disadvantages neighborhoods.
It is important to point out, however, that this research also found that other people of color populations lived closer to opioid treatment resources than White Americans. Despite living near opioid treatment, these populations are known to access this care less than White Americans. For instance, research suggests that Black patients are less likely to be prescribed buprenorphine when presenting opioid use disorder symptoms in emergency rooms than White patients. This is especially noteworthy given that people of color continue to be heavily impacted by the opioid overdose epidemic. Taken together, the present research and the existing literature suggests that proximity to care is not the only barrier to treatment. It is possible that other barriers including social stigma of opioid use disorder and/or health insurance likely contribute to successfully receiving opioid use disorder treatment.
Results suggest that disparities exist in travel distance to sources of opioid use disorder treatment between racial/ethnic composition, socioeconomic status, and rurality of census blocks in the US. Census blocks 1) with American Indian/Alaska Native residents, 2) situated in rural areas, and 3) that were economically disadvantaged were furthest from sources of opioid use disorder treatment. The researchers also found that census blocks in which other people of color resided were closer to opioid treatment programs and buprenorphine providers than those in which White and American Indian/Alaska Natives lived. Taken together, these results suggest that physical distance may serve as a barrier to substance use treatment. However, it is important to acknowledge that due to the recent changes in prescription policies for medications for opioid use disorders, the results should be replicated in this new policy landscape. More research is needed to better understand which barriers to care are most relevant for specific US-based populations, including but not limited to indigenous populations.
Amiri, S., Panwala, V., & Amram, O. (2024). Disparities in access to opioid treatment programs and buprenorphine providers by race and ethnicity in the contiguous US. Journal of Substance Use and Addiction Treatment, 156, 209193. doi:10.1016/j.josat.2023.209193.
l
There has been an increase in racial disparities in opioid-involved overdose deaths with American Indian/Alaska Native and Black populations now having the highest rates of opioid overdose deaths of any race/ethnicity in the US. It is unclear why these groups have experienced a surge in opioid overdose deaths. One possible explanation for these findings is differences in opioid treatment program access. Prior to 2023, physicians could not prescribe medications to treat opioid use disorder (e.g., buprenorphine) without first receiving additional training and a waiver from the government. Such restrictions may have further burdened providers serving these communities which experience higher rates of poverty and marginalization than other groups, resulting in Native American/Black populations having to travel further to access treatment. This barrier could result in lower rates of opioid use disorder medication initiation and sustained engagement over time. To date, however, no studies have examined potential differences in geographic location between racial/ethnic groups. The present research offers insights on how the racial/ethnic characteristics of neighborhoods are associated with geographic distance to opioid treatment programs and buprenorphine providers in the US.
This study used an ecological cross-sectional design- publicly available data from multiple sources were merged to conduct secondary data analysis including 2019 US census tract data used to assess neighborhood characteristics. The study was conducted at the census block level (600-3000 people), resulting in 215,189 block groups. The authors excluded blocks from Alaska and Hawaii because >50 % of land area in Alaska and 10% of land area in Hawaii is not accessible by a road network. Therefore, road distance could not be computed for all block groups in these states. The study also excluded block groups with no population. Regional overdose deaths data were culled from The Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research. The location of opioid treatment programs and buprenorphine providers was derived from the Substance Abuse and Mental Health Services Administration.
The focus of this study was to examine geographic disparities in access to opioid treatment programs and buprenorphine providers by race and ethnicity, neighborhood deprivation, and rurality across the US. Using 2019 Census data the authors categorized block groups based on self-reported predominant racial/ethnic identity of residents. Predominant majority blocks consisted of blocks in which >50% of residents identified with one of racial/ethnic categories adapted from the U.S. Census: American Indian/Alaska Native, Asian, Black, White, Hispanic (regardless of racial identity), or no single racial majority. Block groups where no racial/ethnic identity was endorsed by most of the population were categorized as “no single racial majority”. The authors calculated the percentage of each race/ethnicity residing in census blocks as well. National overdose mortality data from 2019 were used to calculate mortality burden of blocks (e.g., higher, or lower than the national average). The Area Deprivation Index was also used to quantify the economic disadvantage of census blocks, a composite index aggregating factors such as employment, income, and housing. The rurality of census blocks was measured via Rural-Urban Commuting Area codes– a measurement system created by the US Department of Agriculture which measures population density, urbanization, and daily commuting of residents.
The primary outcome of the study was road network distance in miles between a census block group and the nearest opioid treatment program/buprenorphine provider. To measure this the authors geocoded the locations of 1643 opioid treatment providers – which dispense and oversee methadone for opioid use disorder in the US – and 37,692 buprenorphine providers. Next distances between blocks and treatment facilities were calculated using the road network dataset of North America (available on the Environmental Systems Research Institute ArcGIS software).
The researchers utilized statistical modeling to determine the association between racial/ethnic characteristics of census blocks and distance to the nearest source of opioid treatment. These models controlled for overdose cases, economic disadvantage, and rurality of blocks to isolate the effect of race/ethnicity. The authors also identified clusters of block groups with varying patterns of access to opioid treatment. Three patterns emerged from these analyses: clusters of block groups with shorter distances to opioid treatment providers (“hot spots”); block clusters with longer distances to opioid treatment programs (“cold spots”); and clusters which were neither classified as either hot or cold (“neutral zones”).
Analyses revealed that the median road distance between blocks and opioid treatment programs and buprenorphine providers was 8 miles (range 3-20) and 2 miles (range 1-5) respectively. Most of the blocks sampled had a majority White population (62.3%) followed by Hispanic (10.2%), no single race majority (11.5%), Black (8.8%), Asian (1.0%) and American Indian/Alaska Native (.2%). Most census blocks were classified as being in metropolitan areas (80.6%) with the remainder being suburban (13.6%) or rural areas (5.8%). Most census blocks were categorized as not being economically disadvantaged (69.4%). Census blocks were evenly split in terms of overdose deaths; 53.5% reported fewer overdose deaths than the national average, while 42.7% reported more (the remaining blocks had unknown rates of overdose deaths [3.8%]).
American Indian/Alaska Native people were the furthest, while other people of color were the closest
The median distance between majority American Indian/Alaska Native census blocks and the nearest opioid treatment program and buprenorphine providers was 88 and 17 miles, respectively. Statistical models showed that relative to White majority blocks, census blocks that were majority American Indian/Alaska Native were about 35.9 and 9.6 miles further from the nearest opioid treatment program and buprenorphine providers than White people respectively. In contrast, census blocks where other people of color lived were closer to such programs than White people. For example, majority Black blocks were about 5.5 miles closer to opioid treatment programs than White majority blocks.
Rural and economically disadvantaged census blocks were further than less disadvantaged areas
Areas designated as more economically disadvantaged were about 11.3 miles and 2.6 miles from the nearest opioid treatment programs and provider respectively. Census blocks that were less disadvantaged were about 6.9 and 1.9 miles from the nearest opioid treatment programs and provider respectively. Those living in areas designated as small town/rural had to travel 35 and 10 miles further to reach opioid treatment programs and opioid treatment providers respectively compared to metropolitan block groups.
Travel distance was greatest for American Indian/Alaska Native residents in rural, economically disadvantaged areas
In more disadvantaged block groups that contained 25% American Indian/Alaska Native residents, the average travel distance was 59 miles, while in block groups with 75% American Indian/Alaska Native residents, the distance was 84 miles. In small town/rural block groups with 25% American Indian/Alaska Native people, the mean distance to the nearest OTPs was 73 miles compared to 99 miles when 75% of block group residents were American Indian/Alaska Native.
The results of this study suggest that disparities in proximity to opioid treatment exist between race/ethnic, rural, and social class groups in the US. Residents of majority American Indian/Alaska Native census block groups (e.g., those living on reservations) were about 88 and 17 miles from the nearest opioid treatment program and buprenorphine provider, respectively. This is in stark contrast to other majority census block groups which were only about 4 to 10 miles from opioid treatment programs and buprenorphine providers respectively. They also found that the rurality and economic disadvantage of census blocks was associated with travel distance to opioid treatment. Those living in areas rural areas had to travel 35 and 10 miles further to reach opioid treatment programs and opioid treatment providers respectively compared to those living in cities/suburbs. Additionally, the researchers found that the economic disadvantage of a census block was associated with travel distance to opioid use disorder medication providers. Census blocks with more economic disadvantage were about 4 miles and 1.3 miles further from opioid treatment programs and providers respectively than less disadvantaged blocks. The researchers also found that people of color lived closer to sources of opioid medication than White Americans. For instance, Black census block residents lived 5.5 and 2 miles closer to opioid treatment programs and buprenorphine providers respectively than White residents. This finding cannot be explained purely by urban vs. rural location given that models controlled statistically for each block’s rural-urban profile.
These results suggest that physical distance from the opioid use disorder medications methadone and buprenorphine may serve as a barrier for American Indian/Alaska Native residents from receiving care. This may be due to the fact that the number of substance use disorder clinics run by Tribal governments or the Indian Health Service (IHS), a part of the US Department of Health and Human Services, providers remains disproportionately low compared to private clinics. This disparity may be due to underfunding of the IHS. Such underfunding causes delays in treatment which could exacerbate health issues. Therefore, it is possible that increasing funding for IHS may improve treatment access for American Indian/Alaska Native populations. Telemedicine visits for opioid use disorder may also help address these disparities; early studies suggest online video platforms can help increase treatment retention. Of note, the DEA extended regulatory permission to prescribe controlled substances – including opioid use disorder medications like buprenorphine – through the end of 2024. Access to these digital approaches depend of course on access to broadband internet, which may also pose a barrier for those in more remote, economically disadvantages neighborhoods.
It is important to point out, however, that this research also found that other people of color populations lived closer to opioid treatment resources than White Americans. Despite living near opioid treatment, these populations are known to access this care less than White Americans. For instance, research suggests that Black patients are less likely to be prescribed buprenorphine when presenting opioid use disorder symptoms in emergency rooms than White patients. This is especially noteworthy given that people of color continue to be heavily impacted by the opioid overdose epidemic. Taken together, the present research and the existing literature suggests that proximity to care is not the only barrier to treatment. It is possible that other barriers including social stigma of opioid use disorder and/or health insurance likely contribute to successfully receiving opioid use disorder treatment.
Results suggest that disparities exist in travel distance to sources of opioid use disorder treatment between racial/ethnic composition, socioeconomic status, and rurality of census blocks in the US. Census blocks 1) with American Indian/Alaska Native residents, 2) situated in rural areas, and 3) that were economically disadvantaged were furthest from sources of opioid use disorder treatment. The researchers also found that census blocks in which other people of color resided were closer to opioid treatment programs and buprenorphine providers than those in which White and American Indian/Alaska Natives lived. Taken together, these results suggest that physical distance may serve as a barrier to substance use treatment. However, it is important to acknowledge that due to the recent changes in prescription policies for medications for opioid use disorders, the results should be replicated in this new policy landscape. More research is needed to better understand which barriers to care are most relevant for specific US-based populations, including but not limited to indigenous populations.
Amiri, S., Panwala, V., & Amram, O. (2024). Disparities in access to opioid treatment programs and buprenorphine providers by race and ethnicity in the contiguous US. Journal of Substance Use and Addiction Treatment, 156, 209193. doi:10.1016/j.josat.2023.209193.
l
There has been an increase in racial disparities in opioid-involved overdose deaths with American Indian/Alaska Native and Black populations now having the highest rates of opioid overdose deaths of any race/ethnicity in the US. It is unclear why these groups have experienced a surge in opioid overdose deaths. One possible explanation for these findings is differences in opioid treatment program access. Prior to 2023, physicians could not prescribe medications to treat opioid use disorder (e.g., buprenorphine) without first receiving additional training and a waiver from the government. Such restrictions may have further burdened providers serving these communities which experience higher rates of poverty and marginalization than other groups, resulting in Native American/Black populations having to travel further to access treatment. This barrier could result in lower rates of opioid use disorder medication initiation and sustained engagement over time. To date, however, no studies have examined potential differences in geographic location between racial/ethnic groups. The present research offers insights on how the racial/ethnic characteristics of neighborhoods are associated with geographic distance to opioid treatment programs and buprenorphine providers in the US.
This study used an ecological cross-sectional design- publicly available data from multiple sources were merged to conduct secondary data analysis including 2019 US census tract data used to assess neighborhood characteristics. The study was conducted at the census block level (600-3000 people), resulting in 215,189 block groups. The authors excluded blocks from Alaska and Hawaii because >50 % of land area in Alaska and 10% of land area in Hawaii is not accessible by a road network. Therefore, road distance could not be computed for all block groups in these states. The study also excluded block groups with no population. Regional overdose deaths data were culled from The Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research. The location of opioid treatment programs and buprenorphine providers was derived from the Substance Abuse and Mental Health Services Administration.
The focus of this study was to examine geographic disparities in access to opioid treatment programs and buprenorphine providers by race and ethnicity, neighborhood deprivation, and rurality across the US. Using 2019 Census data the authors categorized block groups based on self-reported predominant racial/ethnic identity of residents. Predominant majority blocks consisted of blocks in which >50% of residents identified with one of racial/ethnic categories adapted from the U.S. Census: American Indian/Alaska Native, Asian, Black, White, Hispanic (regardless of racial identity), or no single racial majority. Block groups where no racial/ethnic identity was endorsed by most of the population were categorized as “no single racial majority”. The authors calculated the percentage of each race/ethnicity residing in census blocks as well. National overdose mortality data from 2019 were used to calculate mortality burden of blocks (e.g., higher, or lower than the national average). The Area Deprivation Index was also used to quantify the economic disadvantage of census blocks, a composite index aggregating factors such as employment, income, and housing. The rurality of census blocks was measured via Rural-Urban Commuting Area codes– a measurement system created by the US Department of Agriculture which measures population density, urbanization, and daily commuting of residents.
The primary outcome of the study was road network distance in miles between a census block group and the nearest opioid treatment program/buprenorphine provider. To measure this the authors geocoded the locations of 1643 opioid treatment providers – which dispense and oversee methadone for opioid use disorder in the US – and 37,692 buprenorphine providers. Next distances between blocks and treatment facilities were calculated using the road network dataset of North America (available on the Environmental Systems Research Institute ArcGIS software).
The researchers utilized statistical modeling to determine the association between racial/ethnic characteristics of census blocks and distance to the nearest source of opioid treatment. These models controlled for overdose cases, economic disadvantage, and rurality of blocks to isolate the effect of race/ethnicity. The authors also identified clusters of block groups with varying patterns of access to opioid treatment. Three patterns emerged from these analyses: clusters of block groups with shorter distances to opioid treatment providers (“hot spots”); block clusters with longer distances to opioid treatment programs (“cold spots”); and clusters which were neither classified as either hot or cold (“neutral zones”).
Analyses revealed that the median road distance between blocks and opioid treatment programs and buprenorphine providers was 8 miles (range 3-20) and 2 miles (range 1-5) respectively. Most of the blocks sampled had a majority White population (62.3%) followed by Hispanic (10.2%), no single race majority (11.5%), Black (8.8%), Asian (1.0%) and American Indian/Alaska Native (.2%). Most census blocks were classified as being in metropolitan areas (80.6%) with the remainder being suburban (13.6%) or rural areas (5.8%). Most census blocks were categorized as not being economically disadvantaged (69.4%). Census blocks were evenly split in terms of overdose deaths; 53.5% reported fewer overdose deaths than the national average, while 42.7% reported more (the remaining blocks had unknown rates of overdose deaths [3.8%]).
American Indian/Alaska Native people were the furthest, while other people of color were the closest
The median distance between majority American Indian/Alaska Native census blocks and the nearest opioid treatment program and buprenorphine providers was 88 and 17 miles, respectively. Statistical models showed that relative to White majority blocks, census blocks that were majority American Indian/Alaska Native were about 35.9 and 9.6 miles further from the nearest opioid treatment program and buprenorphine providers than White people respectively. In contrast, census blocks where other people of color lived were closer to such programs than White people. For example, majority Black blocks were about 5.5 miles closer to opioid treatment programs than White majority blocks.
Rural and economically disadvantaged census blocks were further than less disadvantaged areas
Areas designated as more economically disadvantaged were about 11.3 miles and 2.6 miles from the nearest opioid treatment programs and provider respectively. Census blocks that were less disadvantaged were about 6.9 and 1.9 miles from the nearest opioid treatment programs and provider respectively. Those living in areas designated as small town/rural had to travel 35 and 10 miles further to reach opioid treatment programs and opioid treatment providers respectively compared to metropolitan block groups.
Travel distance was greatest for American Indian/Alaska Native residents in rural, economically disadvantaged areas
In more disadvantaged block groups that contained 25% American Indian/Alaska Native residents, the average travel distance was 59 miles, while in block groups with 75% American Indian/Alaska Native residents, the distance was 84 miles. In small town/rural block groups with 25% American Indian/Alaska Native people, the mean distance to the nearest OTPs was 73 miles compared to 99 miles when 75% of block group residents were American Indian/Alaska Native.
The results of this study suggest that disparities in proximity to opioid treatment exist between race/ethnic, rural, and social class groups in the US. Residents of majority American Indian/Alaska Native census block groups (e.g., those living on reservations) were about 88 and 17 miles from the nearest opioid treatment program and buprenorphine provider, respectively. This is in stark contrast to other majority census block groups which were only about 4 to 10 miles from opioid treatment programs and buprenorphine providers respectively. They also found that the rurality and economic disadvantage of census blocks was associated with travel distance to opioid treatment. Those living in areas rural areas had to travel 35 and 10 miles further to reach opioid treatment programs and opioid treatment providers respectively compared to those living in cities/suburbs. Additionally, the researchers found that the economic disadvantage of a census block was associated with travel distance to opioid use disorder medication providers. Census blocks with more economic disadvantage were about 4 miles and 1.3 miles further from opioid treatment programs and providers respectively than less disadvantaged blocks. The researchers also found that people of color lived closer to sources of opioid medication than White Americans. For instance, Black census block residents lived 5.5 and 2 miles closer to opioid treatment programs and buprenorphine providers respectively than White residents. This finding cannot be explained purely by urban vs. rural location given that models controlled statistically for each block’s rural-urban profile.
These results suggest that physical distance from the opioid use disorder medications methadone and buprenorphine may serve as a barrier for American Indian/Alaska Native residents from receiving care. This may be due to the fact that the number of substance use disorder clinics run by Tribal governments or the Indian Health Service (IHS), a part of the US Department of Health and Human Services, providers remains disproportionately low compared to private clinics. This disparity may be due to underfunding of the IHS. Such underfunding causes delays in treatment which could exacerbate health issues. Therefore, it is possible that increasing funding for IHS may improve treatment access for American Indian/Alaska Native populations. Telemedicine visits for opioid use disorder may also help address these disparities; early studies suggest online video platforms can help increase treatment retention. Of note, the DEA extended regulatory permission to prescribe controlled substances – including opioid use disorder medications like buprenorphine – through the end of 2024. Access to these digital approaches depend of course on access to broadband internet, which may also pose a barrier for those in more remote, economically disadvantages neighborhoods.
It is important to point out, however, that this research also found that other people of color populations lived closer to opioid treatment resources than White Americans. Despite living near opioid treatment, these populations are known to access this care less than White Americans. For instance, research suggests that Black patients are less likely to be prescribed buprenorphine when presenting opioid use disorder symptoms in emergency rooms than White patients. This is especially noteworthy given that people of color continue to be heavily impacted by the opioid overdose epidemic. Taken together, the present research and the existing literature suggests that proximity to care is not the only barrier to treatment. It is possible that other barriers including social stigma of opioid use disorder and/or health insurance likely contribute to successfully receiving opioid use disorder treatment.
Results suggest that disparities exist in travel distance to sources of opioid use disorder treatment between racial/ethnic composition, socioeconomic status, and rurality of census blocks in the US. Census blocks 1) with American Indian/Alaska Native residents, 2) situated in rural areas, and 3) that were economically disadvantaged were furthest from sources of opioid use disorder treatment. The researchers also found that census blocks in which other people of color resided were closer to opioid treatment programs and buprenorphine providers than those in which White and American Indian/Alaska Natives lived. Taken together, these results suggest that physical distance may serve as a barrier to substance use treatment. However, it is important to acknowledge that due to the recent changes in prescription policies for medications for opioid use disorders, the results should be replicated in this new policy landscape. More research is needed to better understand which barriers to care are most relevant for specific US-based populations, including but not limited to indigenous populations.
Amiri, S., Panwala, V., & Amram, O. (2024). Disparities in access to opioid treatment programs and buprenorphine providers by race and ethnicity in the contiguous US. Journal of Substance Use and Addiction Treatment, 156, 209193. doi:10.1016/j.josat.2023.209193.
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