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: ) 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. Within the five urban counties, we worked with 23 agency partners and the average agency costs were $10,993.72. Across the three rural counties, costs averaged $61.94 per person reached (1,924; $119,164.54). Among the seven agency partners across the three rural counties, average agency costs were $9,235.38. CONCLUSIONS: By gaining an understanding of the populations benefiting from these services, breadth of services provided, 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://www. CLINICALTRIALS: gov/ct2/show/NCT04111939.