Accessibility of methadone treatment via public transit for syringe services program participants in Miami-Dade County, Florida

This is the authors' abstract. We don't add key points for this paper.

Methadone is an opioid receptor agonist medication used in the treatment of opioid use disorder (OUD). Geographic distance to opioid treatment programs (OTPs) is a major barrier to treatment, given requirements for direct observation of dosing and periodic drug screens, and 'methadone treatment deserts' are defined as a public transit threshold of 30 min. The purpose of this study was to examine public transit access to methadone treatment for participants of a syringe services program (SSP) in Miami-Dade County, Florida. Public transit times were calculated using the R library r5r, which facilitates multi-modal transportation network routing. General Transit Feed Specification data was combined with street network data from OpenStreetMap for Miami-Dade County. Transit times were estimated from the population-weighted centroid of each zip code (n = 73) with participants of Miami's only SSP (n = 1549) to the nearest OTP (n = 4) using 24 departure windows aligned with OTP service hours. The mean one-way transit time from zip codes with SSP participants in Miami-Dade County to the nearest OTP was 79 min. Over 95 % of SSP participants in Miami-Dade County have a mean one-way transit time >30 min, classifying them as residing in 'methadone treatment deserts.' Likewise, 69 of the 73 (95 %) zip codes with SSP participants have a mean transit time to the closest OTP >30 min. Transit times differ substantially between zip codes with different numbers of SSP participants, but not between departure windows. Geographic isolation of methadone treatment from public transit routes represents a significant barrier to equitable OUD treatment.