Hit the Road: Comparing Access to Methadone Maintenance Treatment

8 AM. Stuck in traffic. Fingers tapping impatiently on the steering wheel.

Marc was making his daily drive to the methadone clinic. He needed to get in and out and get to work by 9am. If this bumper-to-bumper situation didn’t improve soon, he’d be late.

As his Honda crept along, Marc glanced at the shops and restaurants he was passing. A Walgreens. A CVS.

He realized that this route to the opioid treatment center went by three different pharmacies. It’d save a ton of time and effort if Marc could just get his methadone filled at one of those pharmacies instead…

With situations like Marc’s in mind, researchers decided to take a closer look at patient driving times to access methadone clinics. Are methadone clinics farther away than pharmacies? Is there a significant difference in access to methadone maintenance treatment? And why would this be important?

Let’s look at the data…

Limitations to Access Methadone Maintenance Treatment

If you’re currently in a methadone maintenance program, current regulations require you to get the medication from a accredited opioid treatment program (OTP). In fact, methadone can only be dispensed from an approved OTP.

However, thanks to the Covid pandemic, regulations have loosened somewhat. They currently allow OTPs to dispense up to four weeks’ of methadone at a time for some patients (instead of a single daily dose). But patients still have to go to their OTP to receive the methadone.

In Canada, the U.K., and Australia, patients can obtain daily doses of methadone at local pharmacies. Some policy makers in the U.S. are calling for a similar change to federal regulations. The argument is that “pharmacy-based dispensing of methadone is an alternative model of care that has the potential to enhance access to methadone maintenance treatment.”

That’s what prompted researchers to conduct a study comparing driving time to local pharmacies vs driving time to the nearest methadone maintenance treatment programs in the United States. They hypothesized that the average driving times from population centers are shorter to the closest pharmacy than to the nearest OTP.

It Turns Out…

Investigators included all 1,724 OTPs in the US and a total of 69,475 unique pharmacy locations in their study. Based on the sheer number of pharmacy locations throughout the nation compared to the number of OTPs, the researchers’ findings were not surprising.

It turns out, people can typically get to a pharmacy faster than to an OTP. Researchers found that “98% of US residents have a shorter drive time to the closest pharmacy than to the closest OTP.” On average, the drive time to the closest OTP was 20.4 minutes. The average drive time to the closest pharmacy was 4.5 minutes.

Researchers found that nearly 18 percent of the population has a drive time of 30 minutes or more to the closest OTP. In contrast, only 0.4 percent of the population lives that far from pharmacies.

The results also differed by region. Some counties had “notably high drive times to OTPs.” These were clustered in the Mountain census division (Montana, Idaho, Wyoming, Nevada, Utah, Colorado, Arizona, and New Mexico).

Researchers also noted that driving times to both OTPs and pharmacies were longer in nonmetropolitan county types. In noncore counties, 85.4 percent of the population had a drive time of more than 30 minutes to an OTP, but only 2.5 percent of individuals lived more than half an hour from a pharmacy.

A Push to Increase Access to Methadone Maintenance

Researchers say the results of this study demonstrate that:

“…a pharmacy-based model of dispensing methadone maintenance treatment has the potential to decrease driving times, distances, and costs for US residents compared with the current OTP-based dispensing model.”

The decreased driving time in access to methadone maintenance treatment could offer several benefits, including:

Decreased cost for patients
Easier access for those with barriers to care (unreliable transportation, extended travel, rural location)
Improved quality of life for individuals receiving methadone treatment

Researchers noted:

“Benefits of in-person administration of methadone at OTPs should be balanced with the low feasibility of commutes in many rural regions of the U.S. Pilot studies may help determine whether pharmacy-based dispensing of methadone maintenance treatment for OUD is effective, safe, and feasible in the U.S.”

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