Introduction: Despite the opioid epidemic adversely affecting areas across the U.S. for more than two decades and increasing evidence that medication-assisted treatment (MAT) is effective for patients with opioid use disorder (OUD), access to treatment is still limited. The limited access to treatment holds true in the Appalachia region despite being disproportionately affected by the crisis, particularly in rural, central Appalachia.
Purpose: This research identifies opportunities for health centers located in high-need areas based on drug poisoning mortality to better meet MAT care gaps. We also provide an in-depth look at health center MAT capacity relative to need in the Appalachia region.
Methods: The analysis included county-level drug poisoning mortality data (2013-2015) from the National Center for Health Statistics (NCHS) and Health Center Program Awardee and Look-Alike data (2017) on the number of providers with a DATA waiver to provide medication-assisted treatment (MAT) and the number of patients receiving MAT for the U.S. Several geospatial methods were used including an Empirical Bayes approach to estimate drug poisoning mortality, excess risk maps to identify outliers, and the Local Moran's I tool to identify clusters of high drug poisoning mortality counties.
Results: High-need counties were disproportionately located in the Appalachia region. More than 6 in 10 health centers in high-need counties have the potential to expand MAT delivery to patients.
Implications: The results indicate an opportunity to increase health center capacity for providing treatment for opioid use disorder in high-need areas, particularly in central and northern Appalachia.
Keywords: Appalachia; geospatial analysis; health centers; medication-assisted treatment (MAT); opioid-use disorder; rural health.
Copyright © 2020 Michael Topmiller, Jennifer Rankin, Jessica L. McCann, Jene Grandmont, David Grolling, Mark Carrozza, Hank Hoang, Josh Bolton, and Alek Sripipatana.