The United States continues to face a severe opioid overdose crisis, with more than 80,000 deaths related to opioid overdose reported in 2023. Although medications for opioid use disorder (MOUD) significantly reduce the risk of overdose, only about one-quarter of people with OUD received MOUD in 2022. Three MOUDs are approved in the U.S, including naltrexone, buprenorphine, and methadone. Methadone has the strongest evidence for reducing overdose risk and improving treatment retention, but it is also the most highly regulated. Access to methadone is largely limited to in-person dispensing at certified opioid treatment programs (OTPs). Daily attendance requirements and limited facility locations create major transportation barriers. These barriers indirectly affect individuals without personal vehicles, like cars, who depend on public transit. A recent study published in JAMA Network Open aimed to examine the methadone access in Connecticut by comparing the travel burdens via personal vehicle and public transit at the census block group (CBG) level.
In this cross-sectional study, geospatial analysis assessed access to OTPs by public transit and personal vehicle across Connecticut. Only publicly available data were used, and human participants were not involved. Addresses of all 29 methadone dispensing OTPs were obtained from the Connecticut Department of Mental Health and Addiction Services. CBGs served as units of analysis, incorporating sociodemographic data from the 2022 American Community Survey, census tract-level car ownership, urban-rural classifications, and opioid-involved overdose death rates from the Connecticut Office of chief medical examiner as a proxy for treatment need.
The primary outcome was the minimum travel time from each CBG to the nearest OTPs. Connecticut was divided into 3000Ă—3000-foot grid cells to estimate homogeneous travel times. Weekday 8 a.m. travel by public transit and car was modeled using Google Maps and transit schedule data, then averaged to the level of CBG. Minimum travel times to the nearest OTP were estimated through grid-based modeling and aggregated to CBGs. Spatial error models assessed associations between travel times and demographics. All statistical analyses were performed using R statistical software, version 4.3.0.
Across 2,702 Connecticut CBGs, the median travel time to the nearest OTP was found to be 11 minutes by personal vehicle (Interquartile range [IQR]: 7.5-16.3) and 41.7 minutes by public transit (IQR: 31-49.5); 1,431 CBGs (53%) had no feasible public transit access. Where transit was available, travel times were substantially longer than driving, with a median transit-to-car ratio of 5.1 (IQR: 4.1-6.4). Travel times increased along the urban-rural gradient: urban CBGs had median times of 8.2 minutes (6.1-11) by car and 32.3 minutes (26.6-44.9) by transit, compared to 19.4 minutes (12.4-27.9) by car and 57.4 minutes (52.6-57.4) by transit in rural CBGs, where 89% (219 trips) lacked transit access. CBGs with higher proportions of White residents had longer travel times, whereas those with more Black or Hispanic residents and higher poverty levels had shorter times. Among 489 CBGs with the highest overdose rates of ≥200 per 100,000, median travel times were 37.6 minutes (27.8-48.5) by transit and 8.2 minutes (5.9-11.7) by car, though 34% (166 trips) lacked transit access. Spatial models showed shorter travel times in urban areas and longer times in CBGs with higher White populations; higher overdose rates were associated with shorter public transit times only.
Limitations of this study include the use of CBG level analyses rather than individual-level measures of access, reliance on per-capita overdose deaths as a proxy for OUD treatment need, lack of consideration of changes in OTP locations over time, exclusion of access to other MOUDs and variation in OTP quality, assumptions about residential travel patterns, and limited generalizability beyond Connecticut.
In conclusion, this study highlights that public transit travel times to methadone treatment in Connecticut were far longer than driving, rendering access infeasible in many suburban and rural areas. Federal regulations requiring in-person dosing at fixed OTPs likely exacerbate these barriers. Geospatial analyses can guide interventions to reduce transportation burdens and expand methadone access.
Reference: Howell BA, Kim J, Thornhill TA, et al. Travel Time to Methadone Treatment Via Personal Vehicle vs Public Transit. JAMA Netw Open. 2026;9(2):e2557361. doi:10.1001/jamanetworkopen.2025.57361
