Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
JAMA Psychiatry. 2020 Nov 1;77(11):1163-1171. doi: 10.1001/jamapsychiatry.2020.1624.
Methadone maintenance is an effective treatment of opioid use disorder, but federal regulations in the US restrict methadone dispensing to opioid treatment programs (OTPs). In Australia, Canada, and the UK, patients can obtain methadone maintenance from community pharmacies.
To compare driving access to methadone maintenance treatment between OTP and pharmacy dispensing models.
DESIGN, SETTING, AND PARTICIPANTS: This descriptive cross-sectional study assessed driving times from census tract mean centers of population to OTPs and pharmacies. Census tracts from the 50 US states and the District of Columbia (based on the 2010 US Census) were included if their population was greater than 0, if their mean center of population (MCP) was within 3 miles of the road network, and if the 1-way driving times from the census tract MCP to both an OTP and a pharmacy were 12 hours or less. Data analyses were performed from November 15, 2019, to April 18, 2020.
The primary outcome was the population-weighted mean driving time from census tract MCPs to OTPs and pharmacies in the US. Census tract MCPs are population-weighted geographic centroids of residents living in each census tract. Driving times were estimated using historical average driving speeds.
All 1682 unique locations of OTPs were included, and 69 475 unique pharmacy locations were included after geocoding. A total of 72 443 census tracts were included in the analysis. The mean population-weighted driving time from census tract MCPs was 20.4 minutes (95% CI, 20.3-20.6 minutes) to OTPs and 4.5 minutes (95% CI, 4.4-4.5 minutes) to pharmacies (P < .001). Differences in driving time, distance, and cost between 1-way trips ending at OTPs and pharmacies were largest in micropolitan and noncore counties.
In this study, population-weighted mean driving times from US census tract MCPs were longer to OTPs than to pharmacies.
美沙酮维持治疗是治疗阿片类药物使用障碍的有效方法，但美国的联邦法规限制美沙酮配给只能在阿片类药物治疗计划（OTP）中进行。在澳大利亚、加拿大和英国，患者可以从社区药房获得美沙酮维持治疗。
比较 OTP 和药房配药模式下获得美沙酮维持治疗的驾驶途径。
设计、设置和参与者：这项描述性的横断面研究评估了从普查区人口平均值中心到 OTP 和药房的驾驶时间。如果人口大于 0 且普查区人口平均值中心（MCP）在道路网络 3 英里内，如果从普查区 MCP 到 OTP 和药房的单向驾驶时间为 12 小时或更短，则纳入美国的 50 个州和哥伦比亚特区（基于 2010 年美国人口普查）的普查区。数据分析于 2019 年 11 月 15 日至 2020 年 4 月 18 日进行。
主要结果是美国从普查区 MCP 到 OTP 和药房的人口加权平均驾驶时间。普查区 MCP 是居住在每个普查区的居民的人口加权地理中心点。驾驶时间使用历史平均驾驶速度进行估计。
共纳入了 1682 个 OTP 的独特位置，地理编码后纳入了 69475 个独特的药房位置。共有 72443 个普查区纳入分析。从普查区 MCP 到 OTP 的人口加权平均驾驶时间为 20.4 分钟（95%CI，20.3-20.6 分钟），到药房的驾驶时间为 4.5 分钟（95%CI，4.4-4.5 分钟）（P<0.001）。单程旅行终点为 OTP 和药房时，驾驶时间、距离和成本的差异在大都市和非核心县最大。
在这项研究中，从美国普查区 MCP 到 OTP 的人口加权平均驾驶时间比到药房的驾驶时间长。
