BACKGROUND Within the United States, there is a shortage of opioid treatment programs (OTPs), facilities which dispense methadone for opioid use disorder. It is unknown how pharmacy-based methadone dispensing, as available internationally, could affect methadone access. We aimed to compare drive times to the nearest OTP with drive times to the nearest chain pharmacy in urban and rural census tracts. METHODS Cross-sectional geospatial analysis of 2018 OTP location data and 2017 pharmacy location data. We included census tracts with non-zero population in Indiana, Kentucky, Ohio, Virginia, and West Virginia, states with highest rates of opioid overdose deaths. Our outcome was minimum drive time in minutes from census tract mean center of population to the nearest dispensing facility. RESULTS Among 7918 census tracts, median (IQR) drive time to OTPs increased from urban to increasingly rural census tract classification [16.1 min (10.2-25.9) to 48.4 min (34.0-63.3);p < .001]. Median (IQR) drive time to OTPs was greater than drive time to chain pharmacies among all census tracts: 19.6 min (11.6-35.1) versus 4.4 min (2.9-7.7) respectively; p < .001. The median (IQR) difference in drive time was greater for increasingly rural census tracts [11.5 min (6.1-19.2) to 35.2 min (19.6-49.7); p <.001] with pharmacy-based methadone dispensing. CONCLUSION Rural census tracts have disproportionately long drive times to OTPs. Drawing from policies to increase methadone access in countries like Canada and Australia, this geographic methadone disparity could be mitigated through implementation of pharmacy-based methadone dispensing.

中文翻译：

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美国五个州基于药房的美沙酮配药和美沙酮治疗的驾驶时间：一项横断面研究。


背景技术在美国，阿片类药物治疗计划（OTP）、为阿片类药物使用障碍分配美沙酮的设施短缺。目前尚不清楚国际上提供的基于药房的美沙酮配药会如何影响美沙酮的获取。我们的目的是比较城市和农村人口普查区中前往最近的 OTP 的驾车时间与前往最近的连锁药房的驾车时间。方法 对 2018 年 OTP 位置数据和 2017 年药房位置数据进行横断面地理空间分析。我们纳入了印第安纳州、肯塔基州、俄亥俄州、弗吉尼亚州和西弗吉尼亚州人口非零的人口普查区，这些州的阿片类药物过量死亡率最高。我们的结果是从人口普查区平均人口中心到最近的配药设施的最短驾驶时间（以分钟为单位）。结果 在 7918 个人口普查区中，从城市到乡村人口普查区分类，前往 OTP 的中位 (IQR) 驾驶时间有所增加 [16.1 分钟 (10.2-25.9) 至 48.4 分钟 (34.0-63.3)；p < .001]。所有人口普查区中，前往 OTP 的驾驶时间中位数 (IQR) 均大于前往连锁药房的驾驶时间：分别为 19.6 分钟 (11.6-35.1) 和 4.4 分钟 (2.9-7.7)； p < .001。越来越多的农村人口普查区的驾驶时间中位数 (IQR) 差异更大 [11.5 分钟 (6.1-19.2) 至 35.2 分钟 (19.6-49.7)； p <.001] 使用基于药房的美沙酮配药。结论 农村人口普查区到 OTP 的驾车时间过长。借鉴加拿大和澳大利亚等国家增加美沙酮获取的政策，这种美沙酮的地理差异可以通过实施基于药房的美沙酮配药来缓解。