Spatial access to medications for opioid use disorder and co-located mental health care

Johns Hopkins University, Baltimore MD

Investigators

Abstract

Medications for opioid use disorder (MOUD) like buprenorphine and methadone are vitally important to prevent overdose-related morbidity and mortality, and early evidence suggests that drug treatment co-located with mental health care (MH) may be particularly effective at retaining people who use opioids (PWUO) in care. However, lack of transportation and long travel times are two of the most cited reasons for not initiating drug treatment, though travel time has not yet been explored for initiating MOUD with co-located MH. My long-term career goal is to become an independent public health investigator whose primary line of research focuses on understanding neighborhood and place-based factors contributing to mental health and substance use-related outcomes for all Americans. My long-term research will be primarily through an urban health lens and using varied quantitative methodologies. Toward this goal, I propose further training in 1) spatial analysis and GIS; 2) place- based determinants of health; 3) mental health service modalities for PWUO; 4) multilevel modeling; 5) dissemination to stakeholders. The proposed research will use these newly developed skills, along with ecological and individual-level data from PWUO, to meet the following aims: 1) Characterize potential spatial access to outpatient medications for opioid use disorder with and without co-located mental health services in Baltimore, MD and five similar U.S. cities; 2) Determine the association between spatial accessibility to MOUD and co-located mental health services and overdose mortality in Baltimore, MD and Milwaukee, WI; 3) Explore the relationship between objective and subjective accessibility on a) MOUD treatment uptake and retention with and without co- located mental health care, and b) non-fatal overdose among a cohort of PWUD (n=600) in Baltimore, MD. To accomplish these aims, I will draw on the proposed training and guidance from my primary mentor, Dr. Susan Sherman (dissemination training). My mentorship team also includes experts in substance use and mental health service utilization (Dr. Mojtabai), spatial analysis (Dr. Curriero) specifically applied to health care access (Dr. Desjardins), and place-based health determinants and multi-level modeling (Dr. Linton). My prior training, experience conducting relevant research, and the expert mentoring team strongly positions me to accomplish these aims.