Assessing Differences in the Availability of Opioid Addiction Therapy Options: Rural Versus Urban and American Indian Reservation Versus Nonreservation.

Background: Opioid misuse is a large public health problem in the United States. Residents of rural areas and American Indian (AI) reservation/trust lands represent traditionally underserved populations with regard to substance‐use disorder therapy. Purpose: Assess differences in the number of opioid agonist therapy (OAT) facilities and physicians with Drug Addiction Treatment Act (DATA) waivers for rural versus urban, and AI reservation/trust land versus non‐AI reservation/trust land areas in Washington State. Methods: The unit of analysis was the ZIP code. The dependent variables were the number of OAT facilities and DATA‐waivered physicians in a region per 10,000 residents aged 18‐64 in a ZIP code. A region was defined as a ZIP code and its contiguous ZIP codes. The independent variables were binary measures of whether a ZIP code was classified as rural versus urban, or AI reservation/trust land versus non‐AI reservation/trust land. Zero‐inflated negative binomial regressions with robust standard errors were estimated. Results: The number of OAT clinics in a region per 10,000 ZIP‐code residents was significantly lower in rural versus urban areas (P =.002). This did not differ significantly between AI reservation/trust land and non‐AI reservation/trust land areas (P =.79). DATA‐waivered physicians in a region per 10,000 ZIP‐code residents was not significantly different between rural and urban (P =.08), or AI reservation/trust land versus non‐AI reservation/trust land areas (P =.21). Conclusions: It appears that the potential for Washington State residents of rural and AI reservation areas to receive OAT is similar to that of residents outside of those areas; however, difficulties in accessing therapy may remain, highlighting the importance of expanding health care insurance and providing support for DATA‐waivered physicians. [ABSTRACT FROM AUTHOR]

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