Assessing Differences in the Availability of Opioid Addiction Therapy Options: Rural Versus Urban and American Indian Reservation Versus Nonreservation. Issue 1 (14th March 2016)

• Record Type: Journal Article
• Authors: Hirchak, Katherine A.; Murphy, Sean M.
• Is Part Of: Journal of rural health. Volume 33:Issue 1(2017:Winter)
• Page Start: 102
• Page End: 109
• Publication Date: 2016-03-14
• Subjects: American Indians -- opioid abuse -- opioid agonist therapy -- rural treatment -- treatment access; Rural health -- Periodicals; Rural health -- United States -- Periodicals; Medicine, Rural -- Periodicals; Medicine, Rural -- United States -- Periodicals; 362.104257
• DOI: 10.1111/jrh.12178
• Languages: English
• ISSNs: 0890-765X

Abstract

Abstract: Background: Opioid misuse is a large public health problem in the United States. Residents of rural areas and American Indian (AI) reservation/trust lands represent traditionally underserved populations with regard to substance‐use disorder therapy. Purpose: Assess differences in the number of opioid agonist therapy (OAT) facilities and physicians with Drug Addiction Treatment Act (DATA) waivers for rural versus urban, and AI reservation/trust land versus non‐AI reservation/trust land areas in Washington State. Methods: The unit of analysis was the ZIP code. The dependent variables were the number of OAT facilities and DATA‐waivered physicians in a region per 10, 000 residents aged 18‐64 in a ZIP code. A region was defined as a ZIP code and its contiguous ZIP codes. The independent variables were binary measures of whether a ZIP code was classified as rural versus urban, or AI reservation/trust land versus non‐AI reservation/trust land. Zero‐inflated negative binomial regressions with robust standard errors were estimated. Results: The number of OAT clinics in a region per 10, 000 ZIP‐code residents was significantly lower in rural versus urban areas ( P = .002). This did not differ significantly between AI reservation/trust land and non‐AI reservation/trust land areas ( P = .79). DATA‐waivered physicians in a region per 10, 000 ZIP‐code residents was not significantly different between rural and urban ( P = .08), or AI reservation/trust land versus non‐AI reservation/trust land areas ( P = .21). Conclusions: It appears that the potential for Washington State residents of rural and AI reservation areas to receive OAT is similar to that of residents outside of those areas; however, difficulties in accessing therapy may remain, highlighting the importance of expanding health care insurance and providing support for DATA‐waivered physicians.