Medicare Beneficiary Receipt of Methadone by Drive Time to Opioid Treatment Programs.

Abstract

Importance: To combat the ongoing opioid crisis, policy makers and public health officials are developing novel policies to increase the availability of medications for opioid use disorder (OUD). An important question is to what extent geographic availability of opioid treatment programs (OTPs) is associated with treatment receipt. Understanding this association may help with developing additional policies to increase medication for OUD dispensing and improve population health outcomes.

Objective: To quantify trends in dispensing methadone to Medicare beneficiaries based on proximity to an OTP.

Design, setting, and participants: This cross-sectional study analyzed 2020 Medicare fee-for-service claims for methadone for beneficiaries with a recent diagnosis of OUD merged with drive times to OTP locations. Medicare beneficiaries enrolled in a Part D prescription plan and diagnosed with OUD in any of the 3 quarters before and during the 2020 quarter of interest were examined.

Exposure: Drive time between the centroid of a beneficiary's zip code and the closest OTP.

Main outcomes and measures: Quarterly methadone receipt among Medicare beneficiaries with a recent OUD diagnosis was assessed using logistic regression models.

Results: In 2020, there were 640 706 Medicare beneficiaries with a recent OUD diagnosis (mean [SD] age, 62.5 [13.5] years; 55.6% female; 65.5% residing in an urban locality at the time of diagnosis). Of these beneficiaries, 9.6% lacked an OTP within a 60-minute drive time. The probability of a beneficiary receiving methadone decreased as the drive time from an OTP increased. Specifically, in urban areas, the likelihood of methadone receipt decreased by a relative 54% from a mean of 5.29% (national interval, 4.27%-6.52%) for beneficiaries who lived within a 5-minute drive of an OTP to 2.39% (national interval, 1.92%-2.98%) for those who lived within a 15-minute drive from an OTP. For rural beneficiaries, the likelihood of methadone receipt decreased by a relative 27% from a mean of 3.42% (national interval, 2.73%-4.28%) for a 5-minute drive time to 2.39% (national interval, 1.92%-2.98%) for a 15-minute drive time. Evidence of a threshold effect at a drive time of 20 minutes was observed for methadone receipt, after which the rate slowed and was similar between urban and rural beneficiaries.

Conclusions and relevance: These findings suggest that the likelihood of methadone receipt may vary based on proximity to OTP facilities. Where OTPs are located may be a contributor to whether an individual receives methadone treatment.