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Assessing Differences in the Availability of Opioid Addiction Therapy Options: Rural Versus Urban and American Indian Reservation Versus Nonreservation
- Hirchak, Katherine A., Murphy, Sean M.
- The Journal of rural health 2017 v.33 no.1 pp. 102-109
- agonists, drug abuse, health services, insurance, physicians, rural areas, rural health, therapeutics, urban areas, Washington (state)
- BACKGROUND: Opioid misuse is a large public health problem in the United States. Residents of rural areas and American Indian (AI) reservation/trust lands represent traditionally underserved populations with regard to substance‐use disorder therapy. PURPOSE: Assess differences in the number of opioid agonist therapy (OAT) facilities and physicians with Drug Addiction Treatment Act (DATA) waivers for rural versus urban, and AI reservation/trust land versus non‐AI reservation/trust land areas in Washington State. METHODS: The unit of analysis was the ZIP code. The dependent variables were the number of OAT facilities and DATA‐waivered physicians in a region per 10,000 residents aged 18‐64 in a ZIP code. A region was defined as a ZIP code and its contiguous ZIP codes. The independent variables were binary measures of whether a ZIP code was classified as rural versus urban, or AI reservation/trust land versus non‐AI reservation/trust land. Zero‐inflated negative binomial regressions with robust standard errors were estimated. RESULTS: The number of OAT clinics in a region per 10,000 ZIP‐code residents was significantly lower in rural versus urban areas (P = .002). This did not differ significantly between AI reservation/trust land and non‐AI reservation/trust land areas (P = .79). DATA‐waivered physicians in a region per 10,000 ZIP‐code residents was not significantly different between rural and urban (P = .08), or AI reservation/trust land versus non‐AI reservation/trust land areas (P = .21). CONCLUSIONS: It appears that the potential for Washington State residents of rural and AI reservation areas to receive OAT is similar to that of residents outside of those areas; however, difficulties in accessing therapy may remain, highlighting the importance of expanding health care insurance and providing support for DATA‐waivered physicians.