5th District Footprint

From 1999 to 2017, more than 399,000 individuals in the U.S. died from a fatal opioid overdose.¹ Although the total number of nonfatal opioid overdoses is unknown, the Centers for Disease Control and Prevention (CDC) reported that from July 2016 to September 2017, the number of nonfatal opioid overdoses treated in emergency rooms rose 30 percent.² The ongoing opioid epidemic is of particular concern in the Fifth District – which includes the District of Columbia, Maryland, North Carolina, South Carolina, Virginia and most of West Virginia – because of the relatively high fatal and nonfatal overdose rates experienced in Fifth District localities.³ This issue of 5th District Footprint explores the question: To what extent do Fifth District residents have access to opioid treatment programs (OTPs) that help those with opioid use disorder?

A growing body of research exists on the economic costs of the opioid epidemic.⁴ While this continues to be an important research focus, this piece explores a component of the opioid epidemic that has received less attention from researchers: access to treatment. Opioid use disorder treatment can be a complex and harrowing process. Research from Harvard University suggests that it takes the average opioid use disorder patient eight years and five to six treatment attempts to achieve one year of sobriety and information from the National Institute on Drug Abuse indicates that one round of treatment costs, on average, $5,980 to $14,112 per year.⁵

OTPs vary in the strategies used to help patients recover with a key differentiating factor being the use of prescription medicines. Medication-assisted treatment (MAT) programs use federally-regulated prescription medications to address patients’ withdrawal symptoms while also offering counseling and behavioral therapy.⁶ Conversely, abstinence-only OTPs do not use prescription medicines and generally require patients to maintain sobriety for the duration of the program. This piece looks at proximity to MAT programs because the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) maintains a comprehensive directory of these OTPs, but not abstinence-only OTPs.⁷ OTPs run by the U.S. Department of Veterans Affairs (VA) have also been excluded because they cannot be accessed by the general population.

In 2017, the national drug overdose mortality rate was 21.7 individuals per 100,000, or 70,237 drug overdose deaths nationwide.⁸ This is a 9.6 percent increase from 2016 when the overdose mortality rate was 19.8 individuals per 100,000.⁹ While not all fatal overdoses are opioid overdoses, prescription and illicit opioids are currently the main drivers of the increasing national overdose mortality rate with opioid overdose deaths accounting for 67.8 percent of all drug overdose deaths in 2017 (47,600 deaths).¹⁰ As of 2017, West Virginia, Ohio, Pennsylvania and the District of Columbia had the highest overdose mortality rates in the country.¹¹ All Fifth District states and the District of Columbia had an increase in overdose mortality rates from 2016 to 2017.¹² At the same time, OTPs are reaching a relatively small percentage of individuals with opioid use disorder. In 2016, 579,528 of the estimated 2.1 million individuals with opioid use disorder nationwide (27.0 percent) were admitted to an OTP.¹³

The map displays proximity to an OTP in terms of distance, with the darkest green indicating areas that are within ten miles of an OTP and the lightest green indicating areas that are more than 60 miles from an OTP. As of August 2018, there are 225 OTPs in the Fifth District. State-level OTP counts range from five OTPs in the District of Columbia to 86 OTPs in Maryland.¹⁴ Thirty of Maryland’s OTPs are located in the city of Baltimore, making it the Fifth District locality with the highest concentration of OTPs. The city of Richmond, Virginia has the second highest concentration with seven OTPs.

The relative absence of OTPs in eastern West Virginia and northwestern Virginia may be explained by the location of the Monongahela, George Washington and Jefferson National Forests. Accordingly, a number of counties in this area have relatively low drug overdose mortality rates at fewer than 20 individuals per 100,000. However, Webster and Pocahontas Counties, West Virginia are outliers in this area as both counties have an overdose mortality rate of more than 30 individuals per 100,000. Similar explanatory factors do not necessarily exist for other parts of the Fifth District that are up to or more than 60 miles from the nearest OTP although low-OTP density areas in southern South Carolina, the western tips of Maryland and Virginia, and northern West Virginia may be covered by OTPs located in adjacent states.