Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.
Subst Use Misuse. 2022;57(13):1904-1917. doi: 10.1080/10826084.2022.2115852. Epub 2022 Oct 11.
In Massachusetts, one-third of pregnant women with opioid use disorder (OUD) do not receive medications for OUD (MOUD), such as buprenorphine and methadone. Research has demonstrated that broadly, access to medications differs by location and by socioeconomic and geographic characteristics of communities, but a comprehensive understanding at the micro-level is lacking. This study aims to identify and characterize access to MOUD treatment among pregnant women in Massachusetts.
We used enhanced two-step floating catchment area analyses, which incorporated supply and demand measures, as well as local drive-time, to determine spatial accessibility to MOUD. We used four publicly available data sources to calculate geographic accessibility to MOUD. We then merged the resulting accessibility indices with data from the American Community Survey to statistically analyze ZIP Code Tabulation Area (ZCTA) characteristics that were associated with geographic accessibility to MOUD among the study population.
We calculated access to 258 opioid (methadone and/or buprenorphine) treatment programs and 2,585 buprenorphine-waivered prescribers among 74,969 pregnant women during the period 2016-2020 in 448 ZCTAs (= 537 ZCTAs). ZCTAs with lower accessibility to both types of MOUD were concentrated in Western Massachusetts. Central Massachusetts had poor accessibility to buprenorphine providers. Accessibility was greater in ZCTAs that were nonmetropolitan, that had higher minority status and langauge vulnerability, and that had less extreme concentration of privilege.
There is a need to improve MOUD access overall, and to enhance access to both types of medications, so pregnant women can choose the one that works best for them.
在马萨诸塞州，三分之一患有阿片类药物使用障碍（OUD）的孕妇未接受 OUD 药物治疗（MOUD），如丁丙诺啡和美沙酮。研究表明，通常情况下，药物的可及性因地理位置以及社区的社会经济和地理特征而异，但缺乏微观层面的全面了解。本研究旨在确定并描述马萨诸塞州孕妇获得 MOUD 治疗的情况。
我们使用增强型两步浮动集水区分析方法，该方法结合了供应和需求措施，以及当地的行车时间，以确定 MOUD 的空间可及性。我们使用了四个公开的数据源来计算 MOUD 的地理可及性。然后，我们将由此产生的可达性指数与美国社区调查数据合并，以统计分析与研究人群 MOUD 地理可及性相关的邮政编码区（ZCTA）特征。
我们计算了在 2016 年至 2020 年期间，在 448 个 ZCTA 中（=537 个 ZCTA）的 74969 名孕妇中，有 258 个阿片类药物（美沙酮和/或丁丙诺啡）治疗方案和 2585 名丁丙诺啡豁免处方医生。阿片类药物和丁丙诺啡可及性较低的 ZCTA 集中在马萨诸塞州西部。马萨诸塞州中部的丁丙诺啡提供者可及性较差。在非都市区、少数民族和语言弱势群体比例较高、特权集中程度较低的 ZCTA 中，可达性更高。
需要全面改善 MOUD 的可及性，并加强两种药物的可及性，以便孕妇能够选择最适合她们的药物。
