Assessment of Community-Level Vulnerability and Access to Medications for Opioid Use Disorder

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Abstract
US opioid overdose deaths increased within both urban and rural communities and continue to rise in the context of the COVID-19 pandemic.1,2 Treatment with the 3 US Food and Drug Administration–approved medications for opioid use disorder (MOUDs), buprenorphine, methadone, and extended-release naltrexone, can reduce opioid overdose deaths,3-5 but they are not equivalent or interchangeable.6 Buprenorphine is a partial opioid agonist available within office-based settings via Drug Addiction Treatment Act of 2000 (DATA 2000) waivers.6,7 Methadone is a full opioid agonist but can only be provisioned at federally certified opioid treatment programs (OTPs).6,7 Extended-release naltrexone is an opioid antagonist and is typically dispensed by a specialty pharmacy and administered by the prescriber.6,7 Research suggests there is variation in patient preference for these 3 medications, and historical, socioeconomic, racial, and other structural factors affect the availability and perceptions of MOUD services.8-11 Given the differences in pharmacology, delivery, and patient preference, the 3 MOUDs should be accessible in all communities to facilitate treatment individualization and maximization of retention.6 However, there is a shortage of MOUD services, disproportionately affecting rural communities, and differences in availability by race, contributing to racial inequities in access.12,13 Most US patients with opioid use disorder (OUD) never initiate an MOUD because of factors such as cost, stigma of medication treatment, acceptability of services, and geographic availability.6,14
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