Bachhuber Marcus A, Cunningham Chinazo O, Lincourt Pat, Jordan Ashly E
New York State Office of Addiction Services and Supports, 501 7Th Avenue, New York, NY, 10018, USA.
Department of Medicine, Oregon Health & Science University, Portland, OR, USA.
Addict Sci Clin Pract. 2025 Jul 31;20(1):60. doi: 10.1186/s13722-025-00592-9.
Spatial accessibility of substance use disorder (SUD) treatment is a crucial component of access and a comprehensive analysis can help to identify if and where a lack of spatial accessibility is a barrier to treatment.
We conducted a cross-sectional analysis of spatial accessibility of SUD treatment (outpatient, opioid treatment program, and residential) in New York State (NYS). We estimated two measures of spatial accessibility: one-way travel time (i.e., drive time for NYS outside of New York City [NYC] and public transit time for NYC) and robustness (i.e., the difference in travel time between the closest and fifth closest facility). Comparison facilities included Federally Qualified Health Centers, dialysis facilities, and hospitals. We compared travel time and robustness by urbanicity (NYC, urban non-NYC, rural) and NYS economic development region using population-weighted paired t-tests.
The percentage of NYS residents within 30 min travel time was 97.2% for outpatient SUD treatment programs and 82.3% for opioid treatment programs. Mean statewide travel time to outpatient SUD treatment programs was comparable to travel time to Federally Qualified Health Centers (difference: 1.0 min [95%CI 0.9 to 1.1; P < 0.001]) and dialysis facilities (difference: 0.1 min [95%CI 0.03 to 0.2; P = 0.01]), and significantly shorter than to hospitals (difference: 5.6 min [95%CI 5.4 to 5.7; P < 0.001]). Travel time to opioid treatment programs was significantly longer than to Federally Qualified Health Centers (difference: -7.4 min [95%CI - 7.6 to - 7.2; P < 0.001]), dialysis facilities (difference: -8.2 min [95%CI - 8.4 to - 8.1; P < 0.001]), and hospitals (difference: - 2.8 min [95%CI - 3.0 to - 2.6; P < 0.001]). Compared with NYC, mean travel time to each type of SUD treatment program was significantly shorter in urban non-NYC areas and longer in rural areas. For robustness, compared with NYC, there was no significant difference in urban non-NYC areas for outpatient and residential SUD treatment programs, but more limited robustness for opioid treatment programs in urban non-NYC areas and all types of SUD treatment programs in rural areas.
We identified widespread spatial accessibility of SUD treatment facilities across NYS. Recent opportunities such as revised federal regulations on opioid treatment program mobile medication units, increased flexibility in using telehealth in opioid treatment programs and other settings, and opioid settlement funding can be leveraged to increase access in rural areas.
物质使用障碍（SUD）治疗的空间可及性是获得治疗的关键组成部分，全面分析有助于确定空间可及性不足是否以及在何处成为治疗的障碍。
我们对纽约州（NYS）SUD治疗（门诊、阿片类药物治疗项目和住院治疗）的空间可及性进行了横断面分析。我们估计了两种空间可及性指标：单程出行时间（即纽约市（NYC）以外的纽约州驾车时间和纽约市的公共交通时间）和稳健性（即最近和第五近设施之间的出行时间差异）。对照机构包括联邦合格健康中心、透析设施和医院。我们使用人口加权配对t检验，按城市化程度（纽约市、非纽约市城区、农村）和纽约州经济发展区域比较出行时间和稳健性。
对于门诊SUD治疗项目，30分钟出行时间内的纽约州居民比例为97.2%，阿片类药物治疗项目为82.3%。全州到门诊SUD治疗项目的平均出行时间与到联邦合格健康中心的出行时间相当（差异：1.0分钟[95%CI 0.9至1.1；P<0.001]），与透析设施的出行时间相当（差异：0.1分钟[95%CI 0.03至0.2；P=0.01]），且显著短于到医院的出行时间（差异：5.6分钟[95%CI 5.4至5.7；P<0.001]）。到阿片类药物治疗项目的出行时间显著长于到联邦合格健康中心的出行时间（差异：-7.4分钟[95%CI -7.6至-7.2；P<0.001]）、透析设施的出行时间（差异：-8.2分钟[95%CI -8.4至-8.1；P<0.001]）和医院的出行时间（差异：-2.8分钟[95%CI -3.0至-2.6；P<0.001]）。与纽约市相比，非纽约市城区到各类SUD治疗项目的平均出行时间显著更短，农村地区则更长。在稳健性方面，与纽约市相比，非纽约市城区的门诊和住院SUD治疗项目没有显著差异，但非纽约市城区的阿片类药物治疗项目以及农村地区所有类型的SUD治疗项目的稳健性更有限。
我们发现纽约州各地SUD治疗设施的空间可及性普遍良好。近期的一些机会，如修订后的联邦关于阿片类药物治疗项目移动给药单元的法规、阿片类药物治疗项目及其他环境中使用远程医疗的灵活性增加以及阿片类药物和解资金等，可用于增加农村地区的可及性。
