Opioid Treatment Deserts: Concept development and application in a US Midwestern urban county

• Published in: PloS one 2021-05, Vol.16 (5), p.e0250324
• Main Authors: Hyder, Ayaz, Lee, Jinhyung, Dundon, Ashley, Southerland, Lauren T, All, David, Hammond, Gretchen, Miller, Harvey J
• Format: Article
• Language: English
• Subjects: Antidotes; Availability; Biology and Life Sciences; Brand names; Buprenorphine; Computer programs; Data analysis; Deserts; Drafting software; Drug abuse; Drug overdose; Ecology and Environmental Sciences; Editing; Emergency medical care; Emergency medical services; Engineering and Technology; Environmental health; Federal agencies; Fire departments; Fires; Funding; Geography; Government programs; Medicine; Medicine and Health Sciences; Methadone; Methodology; Naloxone; Naltrexone; Narcotics; Opioids; Overdose; People and places; Public health; Public safety; Public transportation; Race; Regional analysis; Regional planning; Social sciences; Software; Substance use disorder; Visualization
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0250324

An Opioid Treatment Desert is an area with limited accessibility to medication-assisted treatment and recovery facilities for Opioid Use Disorder. We explored the concept of Opioid Treatment Deserts including racial differences in potential spatial accessibility and applied it to one Midwestern urban county using high resolution spatiotemporal data. We obtained individual-level data from one Emergency Medical Services (EMS) agency (Columbus Fire Department) in Franklin County, Ohio. Opioid overdose events were based on EMS runs where naloxone was administered from 1/1/2013 to 12/31/2017. Potential spatial accessibility was measured as the time (in minutes) it would take an individual, who may decide to seek treatment after an opioid overdose, to travel from where they had the overdose event, which was a proxy measure of their residential location, to the nearest opioid use disorder (OUD) treatment provider that provided medically-assisted treatment (MAT). We estimated accessibility measures overall, by race and by four types of treatment providers (any type of MAT for OUD, Buprenorphine, Methadone, or Naltrexone). Areas were classified as an Opioid Treatment Desert if the estimate travel time to treatment provider (any type of MAT for OUD) was greater than a given threshold. We performed sensitivity analysis using a range of threshold values based on multiple modes of transportation (car and public transit) and using only EMS runs to home/residential location types. A total of 6,929 geocoded opioid overdose events based on data from EMS agencies were used in the final analysis. Most events occurred among 26-35 years old (34%), identified as White adults (56%) and male (62%). Median travel times and interquartile range (IQR) to closest treatment provider by car and public transit was 2 minutes (IQR: 3 minutes) and 17 minutes (IQR: 17 minutes), respectively. Several neighborhoods in the study area had limited accessibility to OUD treatment facilities and were classified as Opioid Treatment Deserts. Travel time by public transit for most treatment provider types and by car for Methadone-based treatment was significantly different between individuals who were identified as Black adults and White adults based on their race. Disparities in access to opioid treatment exist at the sub-county level in specific neighborhoods and across racial groups in Columbus, Ohio and can be quantified and visualized using local public safety data (e.g., EMS runs). Identification