Analysis of the Costs and Reach of Transportation Services to Reduce Barriers to Opioid Use Disorder (OUD) Treatment: Evidence from the Kentucky HEALing Communities Study

Background Medications for opioid use disorder (MOUD) have been proven to be the most effective method for treating individuals with opioid use disorder (OUD). Individuals who are retained on methadone and buprenorphine treatment have a decreased risk of mortality when compared to others with OUD. However, many individuals in need of MOUD face transportation barriers that prevent them from having the requisite access to treatment. Methods As part of the evidence-based practices (EBPs) implemented throughout the HEALing (Helping to End Addiction Long-term ® ) Communities Study (HCS), strategies to reduce transportation barriers to receiving methadone and buprenorphine at partner organizations were identified and implemented. Multiple strategies were employed including transportation agency contracts, bus passes, rideshare services, leased agency vans, and fuel cards. This study provides a description of the number of unique riders, including demographic and geographic characteristics and the costs of providing these transportation services across participating counties. Results Throughout 2023, we partnered with thirty agencies across eight counties to administer $437,481.69 in transportation support services to 7,923 individuals. These services were distributed primarily to individuals who were white (81.8%; 6,483), female (51.9%; 4,112) and between the ages of 35–54 (59.8%; 4,737). The number of individuals reached and expenses were largest among the five urban counties (5,999; $318,317.15), which averaged $53.06 per person. Rural counties averaged $61.94 per person reached (1,924; $119,164.54). A survey was administered among a subpopulation of these individuals, and among this group, 813 of 958 (84.9%) identified transportation as a major barrier to obtaining/staying in care with MOUD. Within this subgroup, 262 individuals (27.3%) made 377 unique transportation service requests (27.7% of all subgroup requests), which included vehicle repairs (81), peer recovery drivers for rides directly to MOUD appointments (73), and bus passes (70). Conclusions By gaining an understanding of the population benefiting from these services and the costs required to address this barrier to care, we may more effectively inform decision-makers on the resources needed to link and retain individuals in treatment. Trial registration ClinicalTrials.gov, NCT04111939. Registered 30 September 2019, https//clinicaltrials.gov/ct2/show/NCT04111939