Risk for opioid overdose mortality higher in Great Lakes, Mountain, South Atlantic regions of US
Residents of the United States’ South Atlantic, Mountain and East North Central, or Great Lakes, sections were as much as four times as likely to be at high risk for opioid overdose mortality as people living in other parts of the country, according to findings recently published in JAMA Network Open.
“Little is known about counties with high rates of opioid overdose mortality but low availability of [opioid use disorder] treatment,” Rebecca L. Haffajee, PhD, MPH, of the department of emergency medicine at the University of Michigan Medical School, and colleagues wrote. “Given the high level of intrastate variability in availability of [medication for opioid use disorder] providers and opioid overdose harms, as well as the importance of targeting resources to counties at highest risk of the mismatch between treatment and harms, we sought to fill that literature gap.”
Haffajee and colleagues compared rates of opioid use disorder medication providers with the rates of opioid overdose mortality of 3,142 counties throughout the U.S. from 2015 to 2017.
They found that these geographical regions were particularly vulnerable to opioid overdose mortality:
- Mountain (New Mexico, Arizona, Utah and Nevada) — OR = 4.15; 95% CI, 1.34-12.89;
- South Atlantic (Virginia, West Virginia, the District of Columbia, Maryland and Florida) — OR = 2.99; 95% CI, 1.26-7.11; and
- East North Central (Ohio, Michigan, Indiana and Illinois) — OR = 2.21; 95% CI, 1.19-4.12.
Researchers also found that a 1% increase in unemployment was tied to increased odds (OR = 1.09; 95% CI, 1.03-1.15) of a county being at high risk for opioid overdose mortality.
Counties with 10 or more primary care clinicians per 100,000 people were at lower risk for opioid overdose deaths than those counties that did not, as were those counties defined as micropolitan (OR = 0.67; 95% CI, 0.5-0.9) vs. metropolitan and those counties that had an additional 1% of the population younger than 25 years (OR = 0.95; 95% CI, 0.92-0.98).
Haffajee and colleagues suggested that based on their findings, resources for opioid use disorder medications and their providers be targeted to the South Atlantic, Mountain and East North Central regions.
“Strategies to increase numbers of [primary care physicians] and other clinicians capable of and willing to provide [medications for opioid use disorder] in these areas may be protective against a county persistently being high risk,” they wrote.
“Other innovative strategies to overcome workforce and geographic barriers — such as telemedicine, engagement of nonphysician prescribers in treatment, addressing stigma, providing peer-to-peer clinician support as in the Project ECHO (Extension for Community Healthcare Outcomes) model, providing hub and spoke models of [opioid use disorder] treatment along the continuum of care, expanding Medicaid to address health care access among low-income and unemployed individuals and dispelling myths —are also likely needed,” Haffajee and colleagues wrote.
They noted that the Substance Abuse and Mental Health Services Administration Substance Abuse Prevention and Treatment Block Grants to states and SUPPORT (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment) for Patients and Communities Act are potential funding sources for such efforts. – by Janel Miller
Disclosures: The authors report no relevant financial disclosures.