AHSR 2021 Abstract
Title: Rural-urban trends in the availability of methadone maintenance
therapy during the beginning of the national opioid crisis
Authors: Amanda G. Sharp, PhD, MPH, Daniel J. Sullivan, PsyD, Amity E.
Quinn, PhD, Constance M. Horgan, ScD, Cindy Parks Thomas, PhD, Timothy B.
Creedon, PhD
Words: 324/350
Background: After two decades, the U.S. has yet to implement adequate
treatment and policy solutions to address the opioid overdose epidemic.
This is despite the existence of multiple forms of effective treatment,
including methadone maintenance therapy (MMT), which had demonstrated
effectiveness for decades before the epidemic began. To better understand
the origins of the epidemic, we investigated early trends in the
availability of MMT, placing emphasis on communities with the highest OUD
treatment need: rural areas with high opioid mortality and misuse rates.
Methods: We conducted secondary analysis of N-SSATS, CDC WONDER, and NSDUH
data merged at the state-year level. We analyzed repeated measures N-SSATS
data on nearly all substance abuse treatment facilities in the U.S. between
2004-2011. Primary outcomes were if facilities offered MMT and, for
comparison, buprenorphine in each study year. Key explanatory variables
were facility location (urban/rural), year, and a rural-year interaction.
We controlled for state-level opioid mortality and misuse rates and a range
of facility-level characteristics. Generalized linear mixed models
estimated differential trends accounting for clustering.
Results: Among N=96,047 facility-year observations, 21.6% were rural. MMT
was available in 9.8% of facilities in 2004 and 11.3% in 2011
(buprenorphine: 7.3%, 2004; 19.1%, 2011; both: 2.4%, 2004; 6.1%, 2011). In
model-based analyses, rural facilities were significantly less likely to
offer methadone than urban facilities (-5.2 pts., p<0.001) and were slower
to add MMT over time (-0.2 pts/year, p=0.005). Buprenorphine was more
available in areas with higher opioid mortality rates (0.8 pts, p<0.001),
but methadone was less available (-1.0 pts., p<0.001).
Conclusions: At the beginning of the opioid epidemic, MMT was least
available where it was needed most: rural communities with higher opioid
mortality rates. Between 2004 and 2011, there was a promising near tripling
of buprenorphine availability, but MMT availability did not meaningfully
change. To help determine what reforms are needed to avert future public
health crises, further research should investigate the role of federal,
state, and local health policies in these trends.
