National Institute of Mental Health, Bethesda, MD, USA.
Research Triangle Institute International, Research Triangle Park, NC, USA.
Addict Sci Clin Pract. 2022 Jan 31;17(1):5. doi: 10.1186/s13722-021-00282-2.
Medications to treat opioid use disorder (OUD) including buprenorphine products are evidence-based and cost-effective tools for combating the opioid crisis. However, limited availability to buprenorphine is pervasive in the United States (US) and may serve to exacerbate the deadly epidemic. Although prior research points to rural counties as especially needy of strategies that improve buprenorphine availability, it is important to investigate the availability of waivered providers according to treatment need as defined by the county-level rate of opioid-overdose deaths (OOD). This study examined differences in buprenorphine provider availability relative to treatment need among rural and urban counties in the US.
Buprenorphine provider availability relative to need in each county was defined as the number of waivered providers divided by the rate of OODs (i.e., number of OODs/100,000 population), according to 2018 data. Counties with ratios in the bottom tertile of their state were classified as buprenorphine undersupplied. We estimated logit models to statistically test the association of rurality and state main effects and their interaction terms (independent variables) and the county classified as buprenorphine undersupplied (dependent variable).
A total of 38 states and 2595 counties had sufficient non-suppressed data to remain in the analysis. A larger percent of urban counties (36.43%) than rural counties (32.01%) were classified as buprenorphine undersupplied (p = 0.001). The likelihood of a rural county being undersupplied varied considerably by state (Chi Square = 82.88, p = 0.000). All states with significant (p < 0.05 or p < 0.10) interaction terms showed lower likelihood of buprenorphine undersupply in rural counties.
The rural-urban distribution in undersupply of waivered buprenorphine providers relative to need varied markedly by state. Strategies for improving access to buprenorphine-waivered providers should be state-centric and informed by county-specific indicators of need.
治疗阿片类药物使用障碍（OUD）的药物，包括丁丙诺啡产品，是对抗阿片类药物危机的循证和具有成本效益的工具。然而，美国普遍存在丁丙诺啡供应有限的问题，这可能会加剧这场致命的流行病。尽管先前的研究指出农村县特别需要制定策略来提高丁丙诺啡的可及性，但根据县一级阿片类药物过量死亡（OOD）率定义的治疗需求，调查有条件批准的提供者的可用性是很重要的。本研究调查了美国农村和县与城市县之间相对于治疗需求的丁丙诺啡提供者的可用性差异。
根据 2018 年的数据，每个县的丁丙诺啡提供者相对于需求的可及性定义为有条件批准的提供者人数除以 OOD 率（即每 10 万人中的 OOD 数）。州内处于州底三分之一的县被归类为丁丙诺啡供应不足。我们估计了对数模型，以统计检验农村和县的州主效应及其交互项（自变量）与县分类为丁丙诺啡供应不足（因变量）之间的关系。
共有 38 个州和 2595 个县有足够的非抑制数据保留在分析中。与农村县（32.01%）相比，更多的城市县（36.43%）被归类为丁丙诺啡供应不足（p=0.001）。农村县被归类为供应不足的可能性因州而异（卡方=82.88，p=0.000）。所有具有显著（p<0.05 或 p<0.10）交互项的州，农村县丁丙诺啡供应不足的可能性都较低。
相对于需求，有条件批准的丁丙诺啡提供者供应不足的城乡分布因州而异。改善有条件批准的丁丙诺啡提供者获取途径的策略应该以州为中心，并根据县一级的需求指标提供信息。
