Geographic access to buprenorphine prescribers for patients who use public transit

• Published in: Journal of substance abuse treatment Vol. 117; p. 108093
• Main Authors: Drake, C., Donohue, J.M., Nagy, D., Mair, C., Kraemer, K.L., Wallace, D.J.
• Format: Journal Article
• Language: English
• Published: Elmsford Elsevier Inc 01-10-2020; Elsevier Limited
• Subjects: Access; Buprenorphine; Censuses; Clustering; Community mental health services; Counties; Geographic access; Households; Medicaid; Medications for opioid use disorder; Mental health professionals; Mental health services; Mortality rates; Opioid use disorder; Opioids; Poisoning; Public transit; Public transportation; Substance abuse; Substance use disorder; Travel; Urban areas; Medications for opioid use disorder; Public transit; Buprenorphine; Opioid use disorder; Medicaid; Geographic access
• ISSN: 0740-5472; 1873-6483
• DOI: 10.1016/j.jsat.2020.108093

Urban Medicaid enrollees with opioid use disorder often rely on public transit to reach buprenorphine prescribers. Research has not shown whether public transit provides this population with adequate geographic access to buprenorphine prescribers. We examined travel times to buprenorphine prescribers by car and public transit in urban areas, and determined whether car-based Medicaid regulatory standards produce their intended geographic coverage.
We obtained data for this study from the Substance Abuse and Mental Health Services Administration's Buprenorphine Practitioner Locator, Microsoft Bing Maps, and the American Community Survey. We examined four urban counties at the centers of the metropolitan statistical areas with the highest 2017 accidental drug poisoning death rates: Kanawha, WV; Montgomery, OH; Philadelphia, PA; and St. Louis City, MO. These counties comprised 696 census tracts representing 1,038,564 households. We calculated travel times from each census tract center to the nearest buprenorphine prescribers by car and public transit, and compared that to 30-min regulatory standards and by whether census tracts had below median levels of car access. We calculated Global Moran's I statistics to determine whether spatial clustering was present among census tracts with limited access to buprenorphine prescribers.
Households in all but two census tracts could access a buprenorphine prescriber within 30 min by car. However, households in 12.1% (84) of census tracts could not do so by public transit. The correlation between car- and public transit-based travel times to the nearest buprenorphine prescriber was 0.11 (95% CI = 0.07–0.22). More than 15% (47,918) of households in the two less densely populated counties could not travel to the nearest prescriber in 30 min and resided in census tracts where access to cars was relatively low. There was no evidence of spatial clustering among census tracts with public transit travel times exceeding 30 min, or among census tracts with public transit travel times exceeding 30 min and below median values of access to cars.
Geographic access to buprenorphine prescribers is overestimated by regulatory standards that apply car-based travel time estimates, which are a weak proxy for public transit-based travel times. Since geographic areas with limited access to buprenorphine prescribers do not tend to cluster near one another, individually targeted interventions may be necessary to improve buprenorphine access and utilization.
•Public transit often does not provide access buprenorphine prescribers in urban areas.•Medicaid access monitoring standards do not capture public transit access to buprenorphine prescribers.•Urban areas with limited geographic access to buprenorphine prescribers tend to be isolated from one another.•Areas with limited public transit access to buprenorphine prescribers often have low rates of car access.•Public transit-based travel times to buprenorphine prescribers can exceed 90 min.