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Original Investigation
July 15, 2020

Comparison of Driving Times to Opioid Treatment Programs and Pharmacies in the US

Author Affiliations
  • 1Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
JAMA Psychiatry. Published online July 15, 2020. doi:10.1001/jamapsychiatry.2020.1624
Key Points

Question  What are the driving times to opioid treatment programs vs pharmacies in the US?

Findings  In this cross-sectional study of driving times, the population-weighted mean 1-way driving time from census tract mean centers of population was 20.4 minutes to opioid treatment programs and 4.5 minutes to pharmacies, a statistically significant difference. Differences in driving time, distance, and cost between 1-way trips ending at opioid treatment programs and pharmacies were largest in micropolitan and noncore counties.

Meaning  In this study, population-weighted mean driving times from US census tract MCPs were longer to OTPs than to pharmacies, suggesting that driving times to methadone maintenance treatment in the US may be reduced with pharmacy-based dispensing of methadone maintenance.

Abstract

Importance  Methadone maintenance is an effective treatment of opioid use disorder, but federal regulations in the US restrict methadone dispensing to opioid treatment programs (OTPs). In Australia, Canada, and the UK, patients can obtain methadone maintenance from community pharmacies.

Objective  To compare driving access to methadone maintenance treatment between OTP and pharmacy dispensing models.

Design, Setting, and Participants  This descriptive cross-sectional study assessed driving times from census tract mean centers of population to OTPs and pharmacies. Census tracts from the 50 US states and the District of Columbia (based on the 2010 US Census) were included if their population was greater than 0, if their mean center of population (MCP) was within 3 miles of the road network, and if the 1-way driving times from the census tract MCP to both an OTP and a pharmacy were 12 hours or less. Data analyses were performed from November 15, 2019, to April 18, 2020.

Main Outcomes and Measures  The primary outcome was the population-weighted mean driving time from census tract MCPs to OTPs and pharmacies in the US. Census tract MCPs are population-weighted geographic centroids of residents living in each census tract. Driving times were estimated using historical average driving speeds.

Results  All 1682 unique locations of OTPs were included, and 69 475 unique pharmacy locations were included after geocoding. A total of 72 443 census tracts were included in the analysis. The mean population-weighted driving time from census tract MCPs was 20.4 minutes (95% CI, 20.3-20.6 minutes) to OTPs and 4.5 minutes (95% CI, 4.4-4.5 minutes) to pharmacies (P < .001). Differences in driving time, distance, and cost between 1-way trips ending at OTPs and pharmacies were largest in micropolitan and noncore counties.

Conclusions and Relevance  In this study, population-weighted mean driving times from US census tract MCPs were longer to OTPs than to pharmacies.

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