Disparities Between US Opioid Overdose Deaths and Treatment Capacity: A Geospatial and Descriptive Analysis

Abstract

Introduction: With opioid-related deaths reaching epidemic levels, gaining a better understanding of access to treatment for opioid use disorder (OUD) is critical. Most studies have focused on 1 side of the equation-either provider capacity or patients' need for care, as measured by overdose deaths. This study examines the overlay between treatment program availability and opioid mortality, comparing accessibility by region. Methods: Geospatial and statistical analyses were used to model OUD treatment programs relative to population density and opioid overdose death incidence at the state and county level. We computed a ratio between program capacity and mortality called the programsper-death (PPD) ratio. Results: There were 40 274 opioid deaths in 2016 and 12 572 treatment programs across the contiguous 48 states, yielding a ratio of 1 program for every 3.2 deaths. Texas had the lowest number of treatment programs per 100 000 persons (1.4) and Maine the highest (13.2). West Virginia ranked highest in opioid deaths (39.09 per 100 000). Ohio, the District of Columbia, and West Virginia had the greatest mismatch between providers and deaths, with an average of 1 program for every 8.5 deaths. Over 32% of US counties had no treatment programs and among those with >10 deaths, nearly 2.5% had no programs. Over 19% of all counties had a ratio 1 provider facility per 10 deaths. Conclusion: Assessing the overlay between treatment capacity and need demonstrated that regional imbalances exist. These data can aid in strategic planning to correct the mismatch and potentially reduce mortality in the most challenged geographic regions.

Outreach to people who survive opioid overdose: Linkage and retention in treatment

“…Other studies have found that peer support intervention models have been associated with improvement in a variety of outcome measures (Bassuk, Hanson, Greene, Richard, & Laudet, 2016). There are significant gaps in access and availability to treatment programs (Langabeer et al, 2019;Rosenblatt, Andrilla, Catlin, & Larson, 2015). Lack of insurance and employment among individuals in our study further complicated access to ongoing care, since most treatment providers do not take Medicaid and state-funded programs often have excessively long wait lists, and the expansion of the state's Medicaid program for substance use disorders would be extremely beneficial for improving access to care for this population.…”

Telehealth sustains patient engagement in OUD treatment during COVID-19

“…Prior to the viral pandemic, MOUD waitlists were lengthy in much of Texas, which is already capacity-constrained ( Langabeer et al, 2019 ), especially for the vulnerable population who lack health insurance, employment, and financial resources. Technology can play a role in improving access and outcomes for OUD, but Ryan Haight Act regulations prohibit the use of telehealth for prescribing controlled substances during “normal” times, without rigorous processes and infrastructure ( Huskamp et al, 2018 ).…”

Alternatives to Arrest for Illicit Opioid Use: A Joint Criminal Justice and Healthcare Treatment Collaboration

“… 10 Demand for treatment far exceeds available capacity. 11 - 13 Accessible treatment options may be hard to find, as online directories are not always updated or accurate and rarely provide all options. 10 The treatment referral process in most communities has room for significant improvement.…”