Variation in a Mid-Atlantic State’s Opioid Response Services by Race, Age, Gender, and Place-Based Economic Indicators

As opioid overdose mortality and morbidity continue to rise in recent years, many states have pursued State Opioid Response (SOR) programs to facilitate access to opioid use disorder treatment. This study characterizes access to care and variation in federally funded SOR programs operating in a state in the Mid-Atlantic region since 2014. This state has experienced high and rising opioid-involved overdose deaths, especially among its Black residents. Using data from 53 jurisdiction-level service providers combined with information on demographic, economic, and social characteristics within a 10-mile radius of the SOR service providers, our research explores the equity of opioid treatment, referral services, and discharge in this Mid- Atlantic State’s SOR programs. From October 2020 through May 2022, our study area’s jurisdiction-level SOR providers served 8,659 adult clients. Among the rate of service received (per 100,000 population) adult men received more service, at 260, compared with adult women, at 110. The rate of service receipt of Black adults (240) was higher than White adults (186). Black SOR service users were prevalent at ages when Social Security Disability Insurance benefits are most common; 49 percent of Black adults served were aged 45 to 64, in contrast with 21 percent of White adults served. Furthermore, the results from the analysis of the services to clients at the SOR communities’ level (within 10 miles of a SOR service provider) show no significant difference in the association between the number of referrals, clients, or MOUD (medication for opioid use disorder) starts, and the poverty level and education level. In addition, the clients from communities with more Black residents were more likely to take up services. The findings also reveal many clients referred, enrolled, or starting MOUD in the SOR program are from the lowest Economic Vulnerability Index (EVI) communities with fewer clients coming from the high EVI communities. In conclusion, access to treatment and recovery services among our study area are relatively equitable across the White and Black race groups; SOR service providers were an important point of access for MOUD with OUD (opioid use disorder) treatment needs living in majority Black communities. There are still great opportunities for outreach in those more economically vulnerable communities. Since rates of opioid-involved overdose deaths continue to grow fastest among Black residents in our study area, future research should examine whether opioid treatment correlates with a decline in opioid-involved deaths and if there is any difference in the quality of SOR provider services delivered by race as well as by type of program.