Distances to access buprenorphine/naloxone treatment in a rural state

Access to buprenorphine/naloxone (BUP/NX) treatment is essential for managing opioid use disorder (OUD), yet significant barriers persist, particularly in rural areas.

This study aims to evaluate the accessibility of BUP/NX treatment in North Dakota by using Prescription Drug Monitoring Program (PDMP) records to calculate distances between individuals and prescribing providers and dispensing pharmacies for BUP/NX treatment in calendar year 2022.

This retrospective study used PDMP records to calculate distance between the ZIP code location of individuals dispensed buprenorphine/naloxone medications, their prescribing providers, and their dispensing pharmacies. Records were grouped in 3 digit ZIP codes to assess geographic and urban-rural variation within North Dakota. Wilcoxon signed-rank tests compared individual-to-pharmacy and individual-to-provider distances within each 3-digit ZIP code region, with a sign test performed as a secondary statewide analysis.

Across North Dakota, the mean individual-to-provider distance was more than twice the individual-to-pharmacy distance, averaging 54.2 miles versus 23.9 miles, respectively. The magnitude of this difference varied across 3-digit ZIP code regions. Wilcoxon signed-rank tests demonstrated significant differences between individual-to-provider and individual-to-pharmacy distances in all regions (p<0.001 for all regions except 586, p=0.017). Completely rural regions had greater individual-to-provider, individual-to-pharmacy, and provider-to-pharmacy distances than regions containing a metropolitan area (all p<0.001).

These findings demonstrate both the potential and the limitations of North Dakota's treatment infrastructure. Pharmacies provide a strong base of access, but prescriber shortages persist as a significant barrier to equitable care. PDMP data offer a valuable surveillance tool to monitor these trends and guide region-specific interventions aimed at reducing opioid-related disparities.