Swann William L, DiNardi Michael, Schreiber Terri L
School of Public Affairs, University of Colorado Denver, Denver, CO, USA.
Department of Economics, University of Rhode Island, Kingston, RI, USA.
Subst Abuse. 2022 Jul 13;16:11782218221111949. doi: 10.1177/11782218221111949. eCollection 2022.
Local governments on the front lines of the opioid epidemic often collaborate across organizations to achieve a more comprehensive opioid response. Collaboration is especially important in rural communities, which can lack capacity for addressing health crises, yet little is known about how local collaboration in opioid response relates to key outputs like treatment capacity.
This cross-sectional study examined the association between local governments' interorganizational collaboration activity and agonist treatment capacity for opioid use disorder (OUD), and whether this association was stronger for rural than for metropolitan communities.
Data on the location of facilities providing buprenorphine and methadone were merged with a 2019 survey of all 358 counties in 5 states (CO, NC, OH, PA, and WA) that inquired about their collaboration activity for opioid response. Regression analysis was used to estimate the effect of a collaboration activity index and its constituent items on the capacity to provide buprenorphine or methadone in a county and whether this differed by urbanicity.
A response rate of 47.8% yielded an analytic sample of n = 171 counties, including 77 metropolitan, 50 micropolitan, and 44 rural counties. Controlling for covariates, a 1-unit increase in the collaboration activity index was associated with 0.155 (95% CI = 0.005, 0.304) more methadone facilities, ie, opioid treatment programs (OTPs), per 100 000 population. An interaction model indicated this association was stronger for rural (average marginal effect = 0.354, 95% CI = 0.110, 0.599) than for non-rural counties. Separate models revealed intergovernmental data and information sharing, formal agreements, and organizational reforms were driving the above associations. Collaboration activity did not vary with the capacity to provide buprenorphine at non-OTP facilities. Spatial models used to account for spatial dependence occurring with OUD treatment capacity showed similar results.
Rural communities may be able to leverage collaborations in opioid response to expand treatment capacity through OTPs.
处于阿片类药物流行前线的地方政府经常跨组织合作，以实现更全面的阿片类药物应对措施。合作在农村社区尤为重要，因为农村社区可能缺乏应对健康危机的能力，但对于阿片类药物应对方面的地方合作如何与治疗能力等关键产出相关，人们了解甚少。
这项横断面研究考察了地方政府的组织间合作活动与阿片类药物使用障碍（OUD）的激动剂治疗能力之间的关联，以及这种关联在农村地区是否比大都市社区更强。
将提供丁丙诺啡和美沙酮的设施位置数据与对5个州（科罗拉多州、北卡罗来纳州、俄亥俄州、宾夕法尼亚州和华盛顿州）所有358个县进行的2019年调查数据合并，该调查询问了它们在阿片类药物应对方面的合作活动。采用回归分析来估计合作活动指数及其构成项目对一个县提供丁丙诺啡或美沙酮能力的影响，以及这种影响是否因城市化程度而异。
47.8%的回复率产生了一个n = 171个县的分析样本，包括77个大都市县、50个微型都市县和44个农村县。在控制协变量的情况下，合作活动指数每增加1个单位，每10万人口中就会多0.155个（95%置信区间 = 0.005，0.304）美沙酮设施，即阿片类药物治疗项目（OTP）。一个交互模型表明，这种关联在农村地区（平均边际效应 = 0.354，95%置信区间 = 0.110，0.599）比在非农村县更强。单独的模型显示，政府间的数据和信息共享、正式协议以及组织改革推动了上述关联。合作活动与非OTP设施提供丁丙诺啡的能力没有差异。用于解释OUD治疗能力中出现的空间依赖性的空间模型显示了类似的结果。
农村社区或许能够利用在阿片类药物应对方面的合作，通过OTP来扩大治疗能力。
