Drug and alcohol dependence reports · 2026
Community-level determinants of buprenorphine provider availability: A ZCTA-level (zip code tabulation area) analysis.
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Jehan Sadia, Seay Kristen D
Аннотация
BACKGROUND: Equitable access to medications for opioid use disorder (MOUD) remains a global challenge. Little is known about community geographic, demographic, and socioeconomic characteristics associated with buprenorphine provider availability following removal of the X-waiver. This study examined these associations across U.S. Zip Code Tabulation Areas (ZCTAs).
METHODS: We analyzed 32,667 ZCTAs from SAMHSA, the U.S. Census, CDC WONDER, and the Missouri Census Data Center. Outcomes were provider availability (≥1 provider/ZCTA) and provider count. Independent variables included dichotomized measures of urban/rural, racial composition, median household income, educational attainment, unemployment, health insurance coverage, and continuous opioid overdose mortality. Multivariable logistic and negative binomial models were estimated.
RESULTS: 30.2% of ZCTAs had at least one provider. Rural ZCTAs had lower provider availability (AOR=0.074, p < .001) and provider counts (IRR=0.070, p < .001). Majority non-White ZCTAs were not significantly associated with either provider availability (AOR=1.1, p = .17) or counts (IRR=1.1, p = .35). Communities with majority less than a bachelor's degree had lower provider availability (AOR=0.50, p < .001) and counts (IRR=0.53, p < .001). Higher unemployment (AOR=1.5; IRR=1.4, both p < .001), lower health insurance coverage (AOR=1.3; IRR=1.2, p < .001), and higher opioid overdose mortality (AOR=1.3; IRR=1.3, both p < .001) were associated with greater provider availability and counts. Low median household income was not associated with provider availability (AOR=1.0, p = .65) but was associated with higher provider counts (IRR=1.2, p < .001).
CONCLUSIONS: Despite the removal of X-waiver, the availability of buprenorphine providers remains limited and uneven. Policies should prioritize equitable distribution of providers to better align treatment capacity with community need, particularly in rural areas.
METHODS: We analyzed 32,667 ZCTAs from SAMHSA, the U.S. Census, CDC WONDER, and the Missouri Census Data Center. Outcomes were provider availability (≥1 provider/ZCTA) and provider count. Independent variables included dichotomized measures of urban/rural, racial composition, median household income, educational attainment, unemployment, health insurance coverage, and continuous opioid overdose mortality. Multivariable logistic and negative binomial models were estimated.
RESULTS: 30.2% of ZCTAs had at least one provider. Rural ZCTAs had lower provider availability (AOR=0.074, p < .001) and provider counts (IRR=0.070, p < .001). Majority non-White ZCTAs were not significantly associated with either provider availability (AOR=1.1, p = .17) or counts (IRR=1.1, p = .35). Communities with majority less than a bachelor's degree had lower provider availability (AOR=0.50, p < .001) and counts (IRR=0.53, p < .001). Higher unemployment (AOR=1.5; IRR=1.4, both p < .001), lower health insurance coverage (AOR=1.3; IRR=1.2, p < .001), and higher opioid overdose mortality (AOR=1.3; IRR=1.3, both p < .001) were associated with greater provider availability and counts. Low median household income was not associated with provider availability (AOR=1.0, p = .65) but was associated with higher provider counts (IRR=1.2, p < .001).
CONCLUSIONS: Despite the removal of X-waiver, the availability of buprenorphine providers remains limited and uneven. Policies should prioritize equitable distribution of providers to better align treatment capacity with community need, particularly in rural areas.