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Introduction
This study aims to assess trends in the number and characteristics of substance use
disorder treatment (SUDT) facilities within the county of residence of adults aged
50+ over time.
Methods
Using retrospective longitudinal data from the 1992-2018 Health and Retirement Study
(HRS) merged to the county-level data on all licensed treatment facilities in the
country, linear mixed models were estimated to calculate geographic accessibility
to SUD treatment (SUDT), adjusted for person-level demographics, state-level controls,
and calendar year fixed effects. Analysis conducted in 2022.
Results
Overall, older adults experienced a decline in the average number of SUDT facilities
within their counties of residence from 4.80 per 100,000 residents (95% CI= 4.69,
4.92) in 1992 to 4.50 (95% CI: 4.35, 4.64) in 2018. However, the number accepting
Medicare increased from 0.26 (95% CI: 0.21, 0.30)) in 1992 to 1.88 (95% CI: 1.80,
1.96) facilities per 100,000 (42% of facilities); Medicaid increased from 0.20 (95%
CI: 0.13, 0.26) in 1992 to 3.50 (95% CI: 3.39, 3.62) facilities per 100,000 (78% of
facilities) in 2018. Older adults living in more rural areas experienced the most
growth in SUDT facilities per capita in their counties but with less significant growth
in facilities offering medication for opioid use disorder (OUD) relative to those
living in more urban areas.
Conclusions
Despite increases in the number of SUDT facilities in rural areas, there has been
less growth in nearby facilities offering evidence-based medication treatment for
OUD.
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