Alibrahim Abdullah, Marsh Jeanne C, Amaro Hortensia, Kong Yinfei, Khachikian Tenie, Guerrero Erick
Industrial & Management Systems Engineering, College of Engineering & Petroleum, Kuwait University, Kuwait, Kuwait.
Geo-Health Lab, Dasman Diabetes Institute, Kuwait, Kuwait.
Subst Use. 2025 Jan 30;19:29768357241312554. doi: 10.1177/29768357241312554. eCollection 2025 Jan-Dec.
Few studies have examined where clients receive methadone treatment for opioid use disorder relative to their residences. Commuting time affects access to care, and anecdotal evidence suggests clients often bypass closer methadone providers. This study quantifies (a) bypass patterns in Los Angeles County, (b) gender, age, and ethnoracial differences in bypassing, and (c) links between bypassing and facility attributes.
Using retrospective multiyear analysis, we matched opioid treatment episodes with commuting times between clients' ZIP codes and treatment facilities. From 16 972 outpatient episodes (2010-2017), data were paired with Google Maps commuting estimates. The study covered 32 methadone facilities and 8627 unique clients. We determined the difference in driving time (a proxy for commuting time) from the nearest (bypassed) provider to the provider where the client was treated, deriving bypass and extended commute rates. We compared the rates of a scaled bypassing variable across racial, ethnic, and gender groups. We examined rates by grouping and by facility characteristics of the closest provider.
Bypassing occurred in 48.9% of episodes; 21.0% involved extra commute time of 5+ minutes beyond the closest facility. Bypass rates varied significantly across racial, ethnic, and gender groups. Black or African American clients showed higher bypass rates than non-Latino white clients. Latino female clients had lower rates and shorter commutes than Latino male clients ( < .01). Larger methadone facilities experienced fewer bypassing and Black clients were found to typically bypass in favor of providers with longer wait times than other groups in the study.
This is the first study investigating client and facility characteristics relating to methadone treatment bypassing in a major U.S. care system. The results highlight significant bypass rates affecting efficient access. Findings have implications for opioid treatment system design, particularly to improve access to quality care for underserved communities.
很少有研究考察阿片类物质使用障碍患者接受美沙酮治疗的地点与他们住所的相对关系。通勤时间会影响获得治疗的机会，且有传闻证据表明患者常常绕过距离更近的美沙酮治疗机构。本研究量化了：（a）洛杉矶县的绕过模式；（b）绕过行为中的性别、年龄和种族差异；以及（c）绕过行为与机构属性之间的联系。
通过回顾性多年分析，我们将阿片类物质治疗事件与患者邮政编码区和治疗机构之间的通勤时间进行匹配。从16972例门诊治疗事件（2010 - 2017年）中，将数据与谷歌地图通勤估算值进行配对。该研究涵盖了32家美沙酮治疗机构和8627名不同的患者。我们确定了从最近（被绕过）的治疗机构到患者实际接受治疗的机构的驾车时间（通勤时间的替代指标）差异，得出绕过率和延长通勤率。我们比较了不同种族、民族和性别组之间的缩放后绕过变量率。我们按分组以及最近治疗机构的特征来检查比率。
48.9%的治疗事件存在绕过情况；21.0%涉及比距离最近的机构额外多5分钟及以上的通勤时间。绕过率在不同种族、民族和性别组之间有显著差异。黑人或非裔美国患者的绕过率高于非拉丁裔白人患者。拉丁裔女性患者的绕过率较低且通勤距离比拉丁裔男性患者短（P < 0.01）。规模较大的美沙酮治疗机构的绕过情况较少，且发现黑人患者通常会绕过，而选择等待时间比研究中的其他组更长的治疗机构。
这是第一项在美国主要医疗系统中调查与美沙酮治疗绕过相关的患者和机构特征的研究。结果凸显了影响有效治疗机会的显著绕过率。研究结果对阿片类物质治疗系统设计有启示，特别是对于改善服务不足社区获得优质治疗的机会。
