Opioid Treatment “Mismatch” Threatens Vulnerable Communities

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MEDICAL ECONOMICS

A “mismatch” between opioid treatment locations and vulnerable communities across the United States could lead to disruptions in care for patients in times of disaster, according to a new study.¹ The research is a result of collaboration across the Yale Program in Addiction Medicine and SEICHE Center for Health and Justice and the University of Chicago’s Healthy Regions & Policies Lab at the Center for Spatial Data Science.

Pandemics like COVID-19 and natural disasters, such as tornados, hurricanes, and wildfires, could disrupt access to buprenorphine, methadone, and extended-release naltrexone—all medications for opioid use disorder (MOUDs), lead study author Paul Joudrey, MD, MPH, said in a press release.² Joudrey is assistant professor of medicine and a Yale Drug Use, Addiction, and HIV Research scholar at Yale School of Medicine in New Haven, Connecticut.

“In plain terms, we are not placing enough services in communities that are more vulnerable to disasters and pandemics,” Joudrey further explained. “If a disaster disrupts medication services, people living within these communities are less likely to receive treatment.”

This mismatch between community vulnerability during disaster and the availability of services was the worst for vulnerable suburban communities—a particularly unique finding, Joudrey added. “We also found that in rural communities, because the availability of services was just bad all around, there was no association between vulnerability and access to medications.”

The study compared treatment facility locations with residents’ social vulnerability across 32,434 zip codes in the United States. The social vulnerability index measured 4 issues: socioeconomic status, household composition and disabilities, racial and ethnic minority status and language, and housing type and transportation.

The investigators found that “zip codes with greater social vulnerability did not have greater geographic access to each of the 3 MOUDs, showing the degree to which the United States falls short of ensuring equitable access to all MOUDs, especially during natural disasters.”¹

In addition, almost 25% of the US continental population lives without access to the medications within a 30-minute drive. The study authors put it in perspective: “Drive times were significantly longer for methadone and extended-release naltrexone relative to dialysis centers, despite the prevalence of OUD being greater than that of ESKD [end-stage kidney disease],” the authors wrote, noting their results were consistent with the emerging literature on these “opioid treatment deserts.”¹

Sadly, the study findings confirm what has been reported in recent natural disasters.

“Hurricane Katrina, Hurricane Sandy, and Hurricane Maria showed that part of the deaths that occur following disasters such as those are because people’s health services were disrupted,” noted coauthor Emily Wang, MD, professor of medicine and of public health and director of the SEICHE Center for Health and Justice. “Our results show that preparedness has too long been only a practice for the middle and upper class. We need to think more deliberately about how preparedness for hurricanes and for COVID-19 includes those placed at highest risk.”²

The authors called for MOUD policy and delivery innovations “to address urban-rural inequities and better match the location of services to communities with greater social vulnerability to prevent inequities in opioid overdose deaths during future disasters.”¹

References

1. Joudrey PJ, Kolak M, Lin Q, Paykin S, Anguiano V Jr, Wang EA. Assessment of community-level vulnerability and access to medications for opioid use disorder. JAMA Netw Open. 2022;5(4):e227028.

2. Parry J. Disasters could disrupt care for opioid use disorder in most vulnerable communities. News release. Yale School of Medicine. April 19, 2022. Accessed April 27, 2022. https://medicine.yale.edu/news-article/disasters-could-disrupt-care-for-opioid-use-disorder-in-most-vulnerable-communities/

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