By Linda Carroll
Drive times to opioid treatment programs may be as much as six times longer in rural U.S. counties compared to urban ones, researchers report.
In a study that looked at drive times to opioid treatment programs in urban and rural counties in the five states with the highest rates of opioid-related deaths, researchers found that it could take nearly 50 minutes to get a clinic that could dispense methadone, according to a report online October 1 in JAMA.
Currently methadone can be dispensed only from U.S. Substance Abuse and Mental Health Services Administration certified opioid treatment programs, which are in short supply in rural areas.
One solution to the problem would be to allow certain primary care clinics to prescribe methadone, said the study's lead author, Dr. Paul Joudrey, an instructor in the department of internal medicine at the Yale School of Medicine in New Haven, Connecticut. But regulators have consistently been opposed to that, he added.
"Historically, there has always been a concern about methadone overdoses and that concern has made methadone for the treatment of opioid use disorder hard to get," Joudrey said. "But what is more dangerous, methadone or heroin and fentanyl?"
Other countries, including Australia, Canada and the UK, "offer methadone in primary care clinics," Joudrey said. "They have created a regulatory structure that allows for primary care clinics to become certified for prescribing methadone for opioid use disorder."
As it stands, the long drive times may be a huge barrier to rural dwellers who have an opioid use disorder, since "the current rules in the U.S. stipulate that a new patient needs to present at the clinic six days a week, Joudrey said. "If you are an hour away, driving six days week to the clinic while doing all the other things you need to do to stay in the program - that has the potential to be a very steep barrier."
Joudrey and his colleagues calculated the minimum drive times from each county's population center to the nearest opioid treatment program as well as the nearest federally funded qualified health center, which as a primary care facility could potentially prescribe methadone.
The researchers determined that the average drive from rural county population centers to an opioid treatment program was 49.1 minutes, whereas the drive in an urban setting was 7.8 minutes. That's compared to an average drive time of 17.3 minutes in rural counties and a drive time of 6.3 minutes in urban counties to a federally qualified health center.
While the researchers present the average drive times from population centers, the trip could take much longer for patients not living in a population center, Joudrey noted.
The new study shows that drive times may be a barrier to patients seeking opioid treatment programs in rural areas, said Dr. Kenneth Stoller, an associate professor in the department of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine in Baltimore and director of the Johns Hopkins Broadway Center for Addiction.
"And I agree with the authors that we are going to need to think more creatively," Stoller said. "But I worry about the field getting a little bit too lax in terms of who is providing methadone treatment. Treatment with methadone can be technically complex especially toward the beginning of treatment, when patients are at higher risk of overdosing or having a toxic reaction to the medication or the combination of the medication and drugs."
There are other possible approaches to the problem, Stoller said. "Telemedicine could be used for the counseling part and there is a potential to extend the reach of treatment through community pharmacies," he added. "People are more likely to access treatment and remain in it if the program is more convenient to access, so it needs to be in the community affected by the opioid epidemic. Pushing it off to hospitals in industrial parks only decreases access."
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