Access to medication for opioid use disorder (MOUD) did not match geographic social vulnerability, according to the results of a study published in JAMA Network Open.

This cross-sectional geospatial analysis was conducted by investigators at the University of Chicago using the social vulnerability index (SVI) data from the United States Centers for Disease Control and Prevention (CDC) and data from the US Substance Abuse and Mental Health Services Administration (SAMHSA). Regional social vulnerability, socioeconomic status, and ethnic minority or language status were related with access to 3 MOUDs. Access to dialysis was used as a comparator.

Among the 32,584 zip code tabulation areas (ZCTAs) in the continental US, 43% were rural, 33% urban, and 25% suburban. There were 198 million adults aged 18-64 years living in the ZCTAs, 76% of whom lived in urban areas, 15% in suburban, and 9% in rural areas.

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The median drive time to the nearest methadone treatment center was 35 (interquartile range [IQR], 16-60) minutes, extended-release naltrexone was 22 (IQR, 9-40) minutes, and buprenorphine was 16 (IQR, 0-30) minutes compared with 20 (IQR, 8-34) minutes for a dialysis center.

Stratified by rurality, drive times were significantly longer for all MOUDs and dialysis (all P <.001).

For locations within 30 minutes, rural areas had no access to methadone (median, vs 0 vs 3), extended-release naltrexone (median, vs 1 vs 20), or dialysis (median, vs 2 vs 16) compared with suburban and urban ZCTAs, respectively. For buprenorphine, there was a median of 1 rural center within a travel time of 30 minutes compared with 6 in suburban and 117 in urban ZTAs (P <.001).

For all areas, greater overall social vulnerability did not correlate with greater access to MOUD. Greater social vulnerability correlated with longer drive times (r, 0.10) and fewer treatment locations (r, 0.11; P <.001) for methadone compared with other MOUDs. However, greater vulnerability according to racial minority and language status correlated with greater access to MOUD.

In rural areas shorter drive times to buprenorphine clinics correlated with increasing social vulnerability (r, -0.10; P <.001) and poorer socioeconomic status (r, -0.13; P <.001). Racial minority and language status correlated with longer drive times (r, 0.16; P <.001) and fewer treatment locations (r, 0.15; P <.001) for extended-release naltrexone.

In suburban areas, greater overall social vulnerability correlated with both longer drive times and fewer available locations. Drive times to methadone clinics increased from the lowest to highest quartile for socioeconomic vulnerability (median, 32 vs 47 min), household composition and disability (median, 33 vs 45 min), and transportation and housing type (median, 35 vs 45 min).

This study did not account for capacity at treatment centers.

The study authors concluded, “In this study, communities within the continental US with greater social vulnerability did not have greater geographic access to buprenorphine, methadone, or extended-release naltrexone. The mismatch between social vulnerability and the location of MOUD services was greatest in suburban zip codes, but rural zip codes had longer drive times to all 3 MOUDs regardless of vulnerability.”

Disclosure: One author declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Joudrey PJ, Kolak M, Lin Q, Paykin S, Anguiano Jr V, Wang EA. Assessment of community-level vulnerability and access to medications for opioid use disorder. JAMA Netw Open. 2022;5(4):e227028. doi:10.1001/jamanetworkopen.2022.7028