Relationship between choice of opioid agonist therapy and distance from patients’ residences in Taiwan, 2012–2014

ABSTRACT

Background

Choice of opioid agonist therapy (OAT) for opioid use disorder (OUD) can be impacted by variables such as age, sex, and socioeconomic status. However, it remains unknown whether accessibility of treatment affects patient choice of OAT.

Objectives

To investigate the association between distance to the treatment site and choice of OAT.

Methods

Electronic records were collected for the last outpatient visits of individuals with OUD between January 1, 2012 and December 31, 2014. The address of each patient was processed using the Geographic Information System to obtain the distance between place of residence and the hospital. Multivariate logistic regression was used to assess the correlation between individual drug selection and distance of residence. Among the study population of 2804 patients (81.5% male), 74.1% were receiving methadone while 25.8% were receiving buprenorphine. The vast majority (95%) of all patients lived within 50 km of the hospital, so regression analysis was limited to this distance. Sensitivity analysis was estimated using robust Poisson regression.

Results

Logistic regression revealed that every 1-km increase in distance from home to hospital increased the odds ratio of choosing sublingual buprenorphine tablets over methadone by 1.05 (p = .02, 95% confidence interval (CI) = 1.02–1.08).

Conclusions

Patients living closer to the treatment center were more likely to choose methadone as treatment, while patients living farther away were more likely to choose sublingual buprenorphine tablets. To mitigate the influence of travel distance on therapy choice, we recommend that more medical institutions participate in OAT services.

KEYWORDS:

• Opioid use disorder
• opioid agonist therapy
• methadone
• buprenorphine
• distance

Acknowledgements

None.

Disclosure Statement

The authors declare no conflicts of interest relevant to this paper.

Notes on Contributors

Author L-C Wei and H-Y Chan designed the study and wrote the protocol of the manuscript. Author L-C Wei collected all the data. Author L-C Wei and H-Y Chan conducted the statistical analyses. Author L-C Wei and H-Y Chan managed the literature searches and analyses. Author L-C Wei wrote the first draft of the manuscript. Author H-Y Chan revised the first draft of the manuscript and finalized the version sent for review. All authors contributed to and have approved the final manuscript.

Additional information

Funding

This research was supported by the Ministry of Health and Welfare [grant number PG10807-0309]. The funding bodies had no role in the study design, collection, analysis, or interpretation of the data, or writing the manuscript.