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Published Online: 2 October 2019

Relationship of County Opioid Epidemic Severity to Changes in Access to Substance Use Disorder Treatment, 2009–2017

Abstract

Objective:

The study measured the association between local opioid problem severity and changes in the availability of substance use disorder treatment programs, including the distance required for travel to treatment.

Methods:

A two-part, multivariable regression estimated the number of treatment facilities in the county (per 100,000 residents) and the number of miles to the nearest program (for all treatment programs, programs offering opioid use disorder medication, and programs accepting Medicaid) using data from the 2009–2017 National Directory of Drug and Alcohol Abuse Treatment Facilities. The unit of analysis was the county-year (N=28,270).

Results:

The probability of having at least one treatment program meeting the established criteria was greater in counties with a high-severity opioid problem than in counties with a low-severity problem, and the probability improved over time. In counties with a high-severity problem, the probability of having a treatment program offering buprenorphine, methadone, or both was 60.3% higher than in counties with low-severity problems. Between 2009 and 2017, the likelihood of having a treatment program that accepts Medicaid grew by 25.3%. For counties without treatment programs, the distance to the nearest program improved markedly over time, but there were no differences between distance to treatment in high-, moderate-, and low-severity status counties.

Conclusions:

The treatment system has reduced structural barriers to treatment where it is most needed. However, these findings do not imply that the treatment system has sufficient capacity to address the present scope of the opioid crisis. Policy makers should leverage this responsiveness to incentivize additional improvements in access.

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Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 12 - 20
PubMed: 31575353

History

Received: 21 March 2019
Revision received: 11 July 2019
Accepted: 26 July 2019
Published online: 2 October 2019
Published in print: January 01, 2020

Keywords

  1. Alcohol &amp
  2. drug abuse, Public policy issues

Authors

Details

Courtney R. Yarbrough, Ph.D. [email protected]
Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Yarbrough); Department of Public Administration and Policy, School of Public and International Affairs (Abraham), and Department of Health Policy and Management, School of Public Health (Adams), University of Georgia, Athens.
Amanda J. Abraham, Ph.D.
Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Yarbrough); Department of Public Administration and Policy, School of Public and International Affairs (Abraham), and Department of Health Policy and Management, School of Public Health (Adams), University of Georgia, Athens.
Grace Bagwell Adams, Ph.D.
Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta (Yarbrough); Department of Public Administration and Policy, School of Public and International Affairs (Abraham), and Department of Health Policy and Management, School of Public Health (Adams), University of Georgia, Athens.

Notes

Send correspondence to Dr. Yarbrough ([email protected]).

Competing Interests

The authors report no financial relationships with commercial interests.

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