Race, rurality and geographic accessibility to medication for opioid use disorder in the U.S.

Figures & data

Figure 1. Maps presenting different depictions of availability and accessibility to MOUD providers in the US. Map 1displays the scarcity of buprenorphine providers with available patient capacity under the DATA-waiver regulation that ended in June 2023. Maps 2 and 3 show the results of the cluster analysis on the spatial accessibility of OTP facilities and buprenorphine providers, respectively, at census tract level.

Three maps are pictured. Map 1 shows the percent buprenorphine providers at waiver capacity by US Census Tract. Overall, 97% of providers have met their capacity and cannot accept new patients. For details of providers at capacity by rurality and racial/ethnic interaction, see Tables 1 and 2. Map 2 and 3 show the distribution of hot and cold spots to methadone and buprenorphine treatment, respectively, in the US. Figures 2 and 3 stratify this information by racial and ethnic interaction, respectively.

Figure 2. OTP (left) and Buprenorphine (right) provider hot and cold spot percent difference from observed and expected values by Black White racial interaction index within census tracts.

Bar charts showing OTP and Buprenorphine provider hot and cold spot percent difference from observed and expected values by Black White racial interaction index within census tracts. Values are presented from no/little White population on the left, increasing to majority White (no Black) as the table moves to the right.

Figure 3. OTP (left) and Buprenorphine (right) provider hot and cold spot percent difference from observed and expected values by Hispanic – not Hispanic ethnic interaction index within census tracts.

OTP Buprenorphine provider hot and cold spot percent difference from observed and expected values by Hispanic-not Hispanic interaction index within census tracts. Values are presented from no/little majority population on the left, increasing to majority population/ no Hispanic as the table moves to the right.

Figure 4. OTP and Buprenorphine (Bup) provider hot and cold spot percent difference from observed and expected values by Black and White racial interaction within census tracts and stratified by 4 class RUCA status.

Hot spot analysis of accessibility results stratified by ethnic segregation and rurality show that Hispanic segregated urban tracts have a moderate deficit of hot and cold spots (−33% OTP cold spots, −8% OTP hot spots, −9% buprenorphine hot spots), indicating more neutral, dispersed high and low accessibility tracts.

Table 1. Mean, count, and median values of accessibility by census tracts for OTPs (OTPAi), Buprenorphine Providers (Bup Ai), and Buprenorphine Waivers (Bup Wvr Ai) per 100,000 adults aged 18-64. Results are stratified by Black and White racial interaction (BW Intrxn) and four class RUCA status. Percent tracts at waiver capacity and with zero buprenorphine access is also shown.

	Black Segregated Urban			Med BW Intrxn Urban			High BW Intrxn Urban			No Black Urban
	Mean	N	Median	Mean	N	Median	Mean	N	Median	Mean	N	Median
OTP Access Index	1.17	16852	0.99	1.10	21014	0.92	1.05	17786	0.86	0.83	3917	0.70
Buprenorphine Access Index	27.03	16852	23.23	27.41	21014	24.04	26.60	17786	23.36	22.08	3917	18.66
Buprenorphine Waiver Access Index	1569.58	16852	1339.76	1650.30	21014	1440.64	1689.18	17786	1459.19	1334.42	3917	1129.68
% Tracts at Waiver Capacity	97.13	16839	97.33	96.95	20979	97.28	97.07	17735	97.31	97.25	3879	97.45
% Tracts Zero Buprenorphine Access	1.55			4.16			6.06			4.52
	Black Segregated Lg Rural			Med BW Intrxn Lg Rural			High BW Intrxn Lg Rural			No Black Lg Rural
	Mean	N	Median	Mean	N	Median	Mean	N	Median	Mean	N	Median
OTP Access Index	0.60	627	0.22	0.78	1698	0.38	0.83	3049	0.47	0.60	806	0.26
Buprenorphine Access Index	17.90	627	13.32	19.97	1698	14.72	23.71	3049	17.45	20.56	806	13.85
Buprenorphine Waiver Access Index	1105.16	627	820.18	1258.30	1698	931.91	1576.20	3049	1185.28	1289.09	806	893.05
% Tracts at Waiver Capacity	96.32	601	100.00	96.59	1675	100.00	96.89	3025	98.82	96.48	760	100.00
% Tracts Zero Buprenorphine Access	3.09			2.85			3.09			5.47
	Black Segregated Sm Rural			Med BW Intrxn Sm Rural			High BW Intrxn Sm Rural			No Black Sm Rural
	Mean	N	Median	Mean	N	Median	Mean	N	Median	Mean	N	Median
OTP Access Index	0.42	286	0.19	0.56	782	0.18	0.55	1534	0.22	0.48	524	0.13
Buprenorphine Access Index	14.08	286	8.67	15.41	782	9.73	21.12	1534	13.99	23.06	524	13.45
Buprenorphine Waiver Access Index	802.24	286	485.93	927.94	782	572.02	1348.51	1534	855.56	1388.82	524	763.82
% Tracts at Waiver Capacity	96.47	267	100.00	96.32	742	100.00	96.49	1470	100.00	96.77	479	100.00
% Tracts Zero Buprenorphine Access	2.26			4.76			7.61			5.35
	Black Segregated Isolated			Med BW Intrxn Isolated			High BW Intrxn Isolated			No Black Isolated
	Mean	N	Median	Mean	N	Median	Mean	N	Median	Mean	N	Median
OTP Access Index	0.26	174	0.00	0.32	470	0.11	0.38	1588	0.08	0.31	774	0.00
Buprenorphine Access Index	16.81	174	9.83	13.30	470	7.58	16.50	1588	9.21	15.64	774	7.57
Buprenorphine Waiver Access Index	1004.34	174	630.61	822.96	470	436.14	1026.69	1588	522.88	922.40	774	440.00
% Tracts at Waiver Capacity	94.97	151	100.00	95.44	411	100.00	96.21	1420	100.00	95.70	620	100.00
% Tracts Zero Buprenorphine Access	2.73			7.02			19.98			18.31

Figure 5. OTP and Buprenorphine (Bup) provider hot and cold spot percent difference from observed and expected values by Hispanic not-Hispanic ethnic interaction within census tracts and stratified by 4 class RUCA status.

Table 2. Mean, count, and median values of accessibility by census tracts for OTPs (OTPAi), Buprenorphine Providers (Bup Ai), and Buprenorphine Waivers (Bup Wvr Ai) per 100,000 adults aged 18-64. Results are stratified by Hispanic and Not Hispanic (HnH Intrxn) ethnic interaction and four class RUCA status. Percent tracts at waiver capacity and with zero buprenorphine access is also shown.

	Hisp Segregated Urban			Med HnH Intrxn Urban			High HnH Intrxn Urban			No Hisp Urban
	Mean	N	Median	Mean	N	Median	Mean	N	Median	Mean	N	Median
OTP Access Index	1.05	19914	0.88	1.08	20497	0.91	1.12	17838	0.94	1.23	1320	1.07
Buprenorphine Access Index	24.57	19914	20.29	27.63	20497	24.66	27.79	17838	24.44	30.25	1320	26.53
Buprenorphine Waiver Access Index	1402.50	19914	1157.80	1666.47	20497	1474.72	1773.68	17838	1535.38	2026.33	1320	1736.44
% Tracts at Waiver Capacity	97.04	19882	97.29	97.01	20451	97.27	97.11	17787	97.37	97.25	1312	97.50
% Tracts Zero Buprenorphine Access	3.80			5.47			6.06			0.95
	Hisp Segregated Lg Rural			Med HnH Intrxn Lg Rural			High HnH Intrxn Lg Rural			No Hisp Lg Rural
	Mean	N	Median	Mean	N	Median	Mean	N	Median	Mean	N	Median
OTP Access Index	0.53	1209	0.18	0.88	1869	0.44	0.78	2765	0.46	0.80	337	0.48
Buprenorphine Access Index	19.33	1209	13.46	22.39	1869	16.46	21.97	2765	16.36	23.79	337	18.10
Buprenorphine Waiver Access Index	1125.52	1209	816.22	1429.66	1869	1079.12	1477.65	2765	1094.08	1649.45	337	1244.79
% Tracts at Waiver Capacity	95.97	1141	100.00	96.59	1846	98.68	97.03	2737	100.00	97.07	337	100.00
% Tracts Zero Buprenorphine Access	8.09			2.85			3.57			0.00
	Hisp Segregated Sm Rural			Med HnH Intrxn Sm Rural			High HnH Intrxn Sm Rural			No Hisp Sm Rural
	Mean	N	Median	Mean	N	Median	Mean	N	Median	Mean	N	Median
OTP Access Index	0.51	484	0.11	0.46	919	0.20	0.57	1522	0.21	0.59	201	0.21
Buprenorphine Access Index	19.21	484	9.23	18.13	919	11.89	19.85	1522	13.52	21.82	201	11.95
Buprenorphine Waiver Access Index	1006.54	484	464.57	1065.78	919	703.72	1289.31	1522	831.55	1604.48	201	850.16
% Tracts at Waiver Capacity	96.21	440	100.00	96.50	872	100.00	96.51	1455	100.00	97.04	191	100.00
% Tracts Zero Buprenorphine Access	5.23			5.59			7.97			1.19
	Hisp Segregated Isolated			Med HnH Intrxn Isolated			High HnH Intrxn Isolated			No Hisp Isolated
	Mean	N	Median	Mean	N	Median	Mean	N	Median	Mean	N	Median
OTP Access Index	0.22	324	0.00	0.35	678	0.07	0.35	1833	0.05	0.51	171	0.12
Buprenorphine Access Index	12.01	324	6.27	14.42	678	7.94	16.67	1833	9.21	18.97	171	10.62
Buprenorphine Waiver Access Index	690.30	324	303.49	836.42	678	446.29	1020.83	1833	517.74	1426.53	171	751.95
% Tracts at Waiver Capacity	95.33	255	100.00	95.30	586	100.00	96.20	1616	100.00	95.95	145	100.00
% Tracts Zero Buprenorphine Access	8.20			10.94			25.80			3.09

Data availability statement

The data that support the findings of this study are available from the corresponding author, P. Mitchell, upon reasonable request.