Efficient engagement: opportunities for mobile methadone maintenance in geographically underserved areas

Area of Science:

• Public Health
• Operations Research
• Addiction Medicine

Background:

• Opioid use disorder (OUD) remains a significant public health crisis.
• Access to medication for opioid use disorder (MOUD), such as methadone, is limited in rural and underserved areas.
• Recent regulatory changes aim to facilitate mobile methadone clinics to address these access gaps.

Purpose of the Study:

• To identify optimal routes for mobile methadone dispensing units.
• To determine the potential number of clients that can be served by mobile clinics.
• To assess the feasibility of mobile methadone services in expanding treatment access.

Main Methods:

• Utilized mixed-integer programming to optimize mobile clinic routes.
• Identified candidate dispensing locations based on geographic access to fixed clinics.
• Conducted case study in Ohio and generalized nationwide analysis, including multi-vehicle scenarios.

Main Results:

• A single mobile methadone vehicle can serve a mean of 60 clients per day in Ohio (range 48-68).
• Nationwide, mobile routes serve a mean of 47.5 clients per day.
• Subsequent vehicle routes from a clinic significantly increase client reach (95% and 93% for 2nd and 3rd vehicles).

Conclusions:

• Mobile methadone maintenance offers a viable solution to reach populations lacking geographic access to fixed clinics.
• Route efficiency and client capacity vary significantly based on geographic factors.
• Policy and funding incentives are crucial to support the operation of mobile methadone units for unmet demand.