Expanding methadone maintenance to pharmacies may reduce driving times, increase access
Methadone maintenance dispensed via pharmacy vs. opioid treatment programs may reduce driving times to receive this treatment in the U.S., according to results of a descriptive cross-sectional study published in JAMA Psychiatry.
“In Canada, Australia and the U.K., individuals with opioid use disorder can obtain methadone from community pharmacies, whereas in the U.S., methadone maintenance treatment for opioid use disorder is primarily dispensed through opioid treatment programs (OTPs),” Robert A. Kleinman, MD, of the department of psychiatry and behavioral sciences at Stanford University School of Medicine, told Healio Psychiatry. “This study compared driving access to OTPs and pharmacies across the U.S. to characterize how driving access might change if methadone could be dispensed through pharmacies.”
Across the U.S., there are currently fewer than 1,700 OTP locations in which patients can access methadone maintenance treatment. Further, rural counties often have shortages of OTPs. Results of prior studies suggested that residents of rural areas have longer driving times to OTPs vs. those of urban areas, and these longer driving distances have been shown to be associated with shorter duration in methadone maintenance treatment.
In the current study, Kleinman and colleagues evaluated driving times from mean centers of population, which are population-weighted geographic centroids for all residents in a census tract, to OTPs and pharmacies. They included census tracts from the 50 U.S. states and the District of Columbia according to the 2010 U.S. Census. Tract inclusion criteria were population greater than zero, mean center of population (MCP) within 3 miles of the road network and one-way driving times from the census tract MCP to both an OTP and a pharmacy of 12 hours or less.
Population-weighted mean driving time from census tract MCPs to OTPs and pharmacies in the U.S. served as the primary outcome. The investigators estimated driving times using historical average driving speeds. They included all 1,682 unique locations of OTPs, 69,475 unique pharmacy locations after geocoding and 72,443 census tracts.
Results showed a mean population-weighted driving time from census tract MCPs of 20.4 minutes (95% CI, 20.3-20.6) to OTPs and 4.5 minutes (95% CI, 4.4-4.5) to pharmacies. Micropolitan and noncore counties had the largest differences in driving time, distance and cost between one-way trips ending at OTPs and pharmacies.
“Methadone maintenance, a potentially lifesaving treatment for individuals with opioid use disorder, can be challenging for patients to access,” Kleinman told Healio Psychiatry. “Pharmacy-based dispensing of methadone has the potential to reduce driving times for individuals taking methadone for opioid use disorder and to reduce urban-rural inequities in access.”
In a related editorial, Paul J. Joudrey, MD, MPH, of the department of internal medicine at Yale School of Medicine, and colleagues highlighted the inadequacies of the federal and state response to expanding methadone access.
“Federal and state agencies are starting to take action to expand geographic access,” they wrote. “The [FDA] proposed to again allow mobile methadone units, and states such as Ohio and Kentucky have passed laws to enable greater use of federally qualified health centers and other facilities for dispensing. While these policies are welcomed, the results here by Kleinman and others suggest they fall short of needed expansion if patients’ rights to evidence-based care for [opioid use disorder] are to be ensured.
“Importantly, even with broad adoption of mobile or pharmacy-based dispensing, patients would still face a long drive time to a central OTP before starting methadone. The only way to address this barrier is to modify [Code of Federal Regulations] 8, and this should be urgently pursued in the context of the ongoing overdose epidemic. It is time for policies that truly support methadone treatment for [opioid use disorder] as opposed to focusing on diversion.”