Comparison between buprenorphine provider availability and opioid deaths among US counties

Jones, Christopher W.; Christman, Zachary; Smith, Christopher M.; Safferman, Michelle R; Salzman, Matthew; Baston, Kaitlan; Haroz, Rachel

doi:10.1016/j.jsat.2018.07.008

Cited by 59 publications

(42 citation statements)

References 28 publications

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“…2 28 Second, high rates of drug-poisoning mortality result not only from greater availability of drugs, but also from greater probability of death with drug use. People living in deprived areas often have inadequate access to substance use disorder treatment and medications [29][30][31][32][33] and limited access to healthcare, 34 resulting from failure to expand Medicaid coverage, inadequate reimbursement for treatment 35 36 and variation in types of providers able to prescribe and manage treatment. 37 Third, as a result of structural violence and barriers, individuals living in deprived communities may be less likely to seek medical treatment due to stigma and criminalisation leading to the higher rates of drug-poisoning mortality.…”

Section: Open Accessmentioning

confidence: 99%

Place, poverty and prescriptions: a cross-sectional study using Area Deprivation Index to assess opioid use and drug-poisoning mortality in the USA from 2012 to 2017

Kurani

McCoy²,

Inselman

et al. 2020

BMJ Open

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ObjectiveTo identify the relationships between county-level area deprivation and patterns of both opioid prescriptions and drug-poisoning mortality.Design, setting and participantsFor this retrospective cross-sectional study, we used the IQVIA Xponent data to capture opioid prescriptions and Centres for Disease Control and Prevention National Vital Statistics System to assess drug-poisoning mortality. The Area Deprivation Index (ADI) is a composite measure of social determinants of health comprised of 17 US census indicators, spanning four socioeconomic domains. For all US counties with available opioid prescription (2712 counties) and drug-poisoning mortality (3133 counties) data between 2012 and 2017, we used negative binomial regression to examine the association between quintiles of county-level ADI and the rates of opioid prescriptions and drug-poisoning mortality adjusted for year, age, race and sex.Primary outcome measuresCounty-level opioid prescription fills and drug-poisoning mortality.ResultsBetween 2012 and 2017, overall rates of opioid prescriptions decreased from 96.6 to 72.2 per 100 people, while the rates of drug-poisoning mortality increased from 14.3 to 22.8 per 100 000 people. Opioid prescription and drug-poisoning mortality rates were consistently higher with greater levels of deprivation. The risk of filling an opioid prescription was 72% higher, and the risk of drug-poisoning mortality was 36% higher, for most deprived compared with the least deprived counties (both p<0.001).DiscussionCounties with greater area-level deprivation have higher rates of filled opioid prescriptions and drug-poisoning mortality. Although opioid prescription rates declined across all ADI quintiles, the rates of drug-poisoning mortality continued to rise proportionately in each ADI quintile. This underscores the need for individualised and targeted interventions that consider the deprivation of communities where people live.

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Section: Open Accessmentioning

confidence: 99%

Place, poverty and prescriptions: a cross-sectional study using Area Deprivation Index to assess opioid use and drug-poisoning mortality in the USA from 2012 to 2017

Kurani

McCoy²,

Inselman

et al. 2020

BMJ Open

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“…It has been well documented that expanded access to medications for OUD is associated with reduced overdose mortality, among other public health benefits . In fact, providing medications for OUD for individuals in the criminal justice system, particularly those in the high‐risk postincarceration period, shows promise in reducing overdose death rates .…”

Section: Public Health Responsesmentioning

confidence: 99%

Epidemiology of the U.S. opioid crisis: the importance of the vector

Compton

Jones

2019

Annals of the New York Academy of Sciences

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The roots of the remarkably lethal U.S. opioid crisis are complex and inextricably entangled with healthcare, especially in its treatment of another serious health problem: pain. Failures of the healthcare system—including lack of both training in pain management and caution in using an addictive class of medications—precipitated the rise in opioid misuse and addiction over the past two decades, but a wider range of social and economic forces has helped perpetuate the crisis and altered its character. The classic epidemiologic host–agent–environment triad can be augmented for the purpose of elucidating the current opioid crisis by addition of the “vector” to emphasize the importance of purveyors of opioids (licit and illicit), leading to our proposing an expanded host–agent–vector–environment model. Interventions addressing multiple components are needed, including solutions that account for behaviors of all vectors associated with the crisis. For prescription opioids, the vectors include clinicians and pharmaceutical‐related companies involved in marketing, prescribing, distributing, and dispensing opioid medications; for illicit opioids, they include drug manufacturing and distribution networks. Attending to the vectors of opioids, while simultaneously implementing a full range of public health, clinical, law enforcement, and other approaches to ending the opioid crisis, may help to improve public health outcomes.

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“…Gaps exist in availability and accessibility of OTPs and OBBTs across the United States. 4,16,17 Long distance to OTPs is associated with decreased length of stay in treatment, poorer treatment adherence, and reduced treatment retention. [18][19][20] Results of a US nationwide study showed that approximately 25% of clients receiving methadone commuted more than 15 miles and 8% traveled more than 50 miles to receive treatment.…”

Section: Introductionmentioning

confidence: 99%

Disparities in Access to Opioid Treatment Programs and Office-Based Buprenorphine Treatment Across the Rural-Urban and Area Deprivation Continua: A US Nationwide Small Area Analysis

et al. 2021

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Objectives: To measure access to opioid treatment programs (OTPs) and office-based buprenorphine treatment (OBBTs) at the smallest geographic unit for which the Census Bureau publishes demographic and socioeconomic data (ie, block group) and to explore disparities in access to treatment across the rural-urban and area deprivation continua across the United States.Methods: Access to OTPs and OBBTs at the block group in 2019 was quantified using an innovative 2-step floating catchment area technique that accounts for the supply of treatment facilities relative to the population size, proximity of facilities relative to the location of population in block groups, and time as a barrier within catchments. Block groups were stratified into tertiles based on the rural-urban continuum codes (metropolitan, micropolitan, small town, or rural) and area deprivation index (least-deprived, middle-deprived, most-deprived). The Integrated Nested Laplace Approximation approach was used for statistical analysis.Results: Across the United States, 3329 block groups corresponding to 2 915 949 adults lacked access to OTPs within a 2-hour drive of their community and 130 block groups corresponding to 86 605 adults did not have access to OBBTs. Disparities in access to treatment were observed across the urban-rural and area deprivation continua including (1) lowest mean access score to OBBTs were found among most-deprived small towns, and (2) lower mean access score to OTPs were found among micropolitan and small towns. Conclusions:The results of this study revealed disparities in access to medication-assisted treatment. The findings call for creative initiatives and local and regional policies to develop to mitigate access problems.

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Comparison between buprenorphine provider availability and opioid deaths among US counties

Cited by 59 publications

References 28 publications

Place, poverty and prescriptions: a cross-sectional study using Area Deprivation Index to assess opioid use and drug-poisoning mortality in the USA from 2012 to 2017

Place, poverty and prescriptions: a cross-sectional study using Area Deprivation Index to assess opioid use and drug-poisoning mortality in the USA from 2012 to 2017

Epidemiology of the U.S. opioid crisis: the importance of the vector

Disparities in Access to Opioid Treatment Programs and Office-Based Buprenorphine Treatment Across the Rural-Urban and Area Deprivation Continua: A US Nationwide Small Area Analysis

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