A Spatial Epidemiologic Analysis of Opioid Use Disorder Treatment in New York State

Opioid agonist treatments (OAT; methadone and buprenorphine) for opioid use disorder (OUD) reduce overdose death by more than 50%. Low population-level rates of OAT are missed opportunities to reduce OUD-related mortality.

We examined county-level OAT utilization patterns to guide state-level and county-level initiatives to improve equitable access and utilization in New York State (NYS).

We calculated NYS county-level methadone and buprenorphine population utilization rates per 100,000 residents by county of patient residence using NYS Office of Addiction Services and Supports and public access datasets.

We mapped rates onto counties and conducted analyses to assess if utilization varied by county, and to identify areas of high utilization (hot spots) and low utilization (cold spots). We used t tests and Fisher exact tests to compare county-level factors.

County-level buprenorphine and methadone utilization rates were 673.76 and 132.19 per 100,000 residents, respectively. Buprenorphine hot spot counties had significantly lower proportions of unemployed (-1.4, P- value<0.01), and higher proportions of non-Hispanic white residents (+50.1, P value<0.01) than counties identified as buprenorphine cold spots. Methadone hot spot counties had significantly higher proportions of unemployed (+1.0, P- value<0.01) and lower proportions of non-Hispanic white residents (-48.1, P- value<0.01) than counties identified as methadonecold spots. All buprenorphine cold spot counties were methadone hot spot counties.

We found that OAT utilization rates differed by race/ethnicity and socioeconomic factors at the county level consistent with national and other state-level findings. Ensuring equitable OAT access must be part of a coordinated response to address the overdose crisis.