Estimation and Comparison of Travel Burden to Outpatient, Opioid Treatment Program, and Residential Substance Use Disorder Treatment Programs.

Abstract

Background: Transportation can be a significant access barrier to effective substance use disorder (SUD) treatment and potentially influence treatment decisions. We aimed to estimate and compare the travel time and cost for outpatient (3 visits/week), opioid treatment program (OTP, 3 visits/week), and residential treatment (1 visit).

Methods: For a 28-day period, we compared travel time and costs for SUD treatment programs using a cross-sectional geospatial analysis of New York State data (March 2024). We estimated travel times using public transit in New York City (NYC) and driving outside of NYC. We estimated travel costs using public transit fares and the standard mileage rate. For comparisons, we used population-weighted paired t-tests both statewide and within urbanicity categories (NYC, urban non-NYC, and rural).

Results: Statewide, OTPs required the longest mean travel times (7.8 hours) and highest mean costs ($139.92), followed by outpatient treatment (4.4 hours, $80.15) and residential treatment (35.9 minutes, $9.28), with a similar pattern in each urbanicity category. In rural areas, compared with residential treatment, the mean travel time for outpatient treatment was longer by 7.44 hours (95% CI: 7.27, 7.61) and more costly by $206.47 (95% CI: 201.03, 211.90) and the mean travel time for OTPs was longer by 13.06 hours (95% CI: 12.75, 13.37) and more costly by $399.67 (95% CI: 388.36, 410.98). Further, in rural areas, compared with outpatient treatment, the mean travel time to OTPs was longer by 5.61 hours (95% CI: 5.32, 5.92) and more costly by $193.21 (95% CI: 181.98, 204.43).

Conclusions: Transportation burdens are significantly higher for outpatient treatment and OTPs compared with residential treatment, and for OTPs compared with outpatient treatment, especially in rural areas. Reducing travel time and cost through strategies including telehealth, flexible methadone take-home dosing, mobile medication units, and integration of methadone treatment into other outpatient programs are needed to improve accessibility.