title: Assessing Differences in the Availability of Opioid Addiction Therapy Options: Rural Versus Urban and American Indian Reservation Versus Nonreservation.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: Department of Human Development, Prevention Science Program, Washington State University, Pullman, Washington.|Health Sciences Spokane, Washington State University, Spokane, Washington.
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Hirchak
authors.affiliation: Health Sciences Spokane, Washington State University, Spokane, Washington.|Department of Health Policy and Administration, Spokane, Washington.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Murphy
mesh_terms: D000073316:Addiction Medicine / Q000706:statistics & numerical data / Q000639:trends; D000293:Adolescent; D000328:Adult; D005260:Female; D062305:Geographic Mapping; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders; D016012:Poisson Distribution; D012424:Rural Population / Q000706:statistics & numerical data; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000628:therapy*; D014505:Urban Population / Q000706:statistics & numerical data; D014861:Washington
keywords: American Indians; opioid abuse; opioid agonist therapy; rural treatment; treatment access