Where Do Clients Receive Methadone Treatment? Exploring Bypassing Behaviors in Methadone Treatment Clients: Temporal, Geographic, and Demographic Factors.

Background: 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.

Methods: 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.

Results: 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 (P < .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.

Implications: 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.