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Drive Time to Addiction Treatment Facilities Providing Contingency Management across Rural and Urban Census Tracts in
Paul J Joudrey1, Kevin Chen, Benjamin J Oldfield
1From the Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (PJJ); Office of Ambulatory Care and Population Health, New York City Health and Hospitals Corporation, New York, NY (KC); Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, NY (KC); Fair Haven Community Health Care, New Haven, CT (BJO); Yale Program in Addiction Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (BJO, EM, DAF); Department of Emergency Medicine, Yale School of Medicine, New Haven, CT (DAF); Department of Health Policy and Management, Yale School of Public Health, New Haven, CT (DAF).
Objective:
We examined drive times to outpatient substance use disorder treatment providers that provide contingency management (CM) and those that integrate CM with medication for opioid use disorder (MOUD) services in 6 US states.
Methods:
We completed cross-sectional geospatial analysis among census tracts in Delaware, Louisiana, Massachusetts, North Carolina, New York, and West Virginia. We excluded census tracts with a population of zero. Using data from the 2020 Shatterproof substance use treatment facility survey, our outcome was the minimum drive time in minutes from the census tract mean center of population to the nearest outpatient CM provider, outpatient CM provider with MOUD services, and federally qualified health centers (FQHC). We stratified census tracts by 2010 Rural-Urban Commuting Area codes and by state.
Results:
The population was greater than zero in 11,719 of 11,899 census tracts. The median drive time to the nearest CM provider was 12.2 [interquartile range (IQR), 7.0-23.5) minutes and the median drive time to the nearest CM provider increased from 9.7 (IQR, 6.0-15.0) minutes in urban census tracts to 38.8 (IQR, 25.4-53.0) minutes in rural ( H = 3683, P < 0.001). The median drive time increased to the nearest CM provider with MOUD services [14.2 (IQR, 7.9-29.5) minutes, W = 18,877, P < 0.001] and decreased to the nearest FQHC [7.9 (IQR, 4.3-13.6) minutes, W = 11,555,894, P < 0.001].
Conclusions:
These results suggest limited availability of CM, particularly within rural communities and for patients needing concurrent CM and MOUD treatment. Our results suggest greater adoption of CM within FQHCs could reduce urban-rural disparities in CM availability.
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