@article{ref1,
title="Assessing differences in the availability of opioid addiction therapy options: rural versus urban and American Indian reservation versus nonreservation",
journal="Journal of rural health",
year="2017",
author="Hirchak, Katherine A. and Murphy, Sean M.",
volume="33",
number="1",
pages="102-109",
abstract="Background 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. <br><br>PURPOSE 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. <br><br>METHODS 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. <br><br>RESULTS 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). <br><br>CONCLUSIONS 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.<p /> <p>Language: en</p>",
language="en",
issn="0890-765X",
doi="10.1111/jrh.12178",
url="http://dx.doi.org/10.1111/jrh.12178"
}