Shortages of Medication-Assisted Treatment for Opioid Use Disorder in Underserved Michigan Counties: Examining the Influence of Urbanicity and Income Level.

Overdose-death rates continue to rise, necessitating accessible medication-assisted treatment (MAT). However, national data demonstrate rural shortages. The purpose of the study was to investigate rural/urban comparisons in the Midwest and simultaneously examine the influence of rural and low-income status. We extracted 2018 public data for Michigan's 83 counties on two MAT forms: 1) methadone clinics and 2) waivered buprenorphine practitioners. Urbanicity was operationalized using Rural Urban Continuum Codes. Income was categorized with U.S. Census data. Bivariate analyses demonstrated MAT shortages among rural (ps < .001) and low-income counties (ps < .01). In multivariable analyses, urban counties were 35.6 and 12.2 times more likely than rural counties to have any clinic(s) (p < .001) or practitioner(s) (p < .05), respectively. High-income counties were 5.9 times more likely than low-income counties to have any practitioner(s) (p < .01). These state-level findings identify targeted Michigan counties currently underserved for available MAT. Expanding treatment access to underserved communities using economic approaches is urgently needed.