PROJECT SUMMARY Medications for opioid use disorder (MOUD) improve the health of individuals with opioid use disorder (OUD). However, there are significant gaps in obtaining services at each step of the opioid treatment cascade. Individual’s access to MOUD vary by community characteristics, most often characterized simply by physical availability (e.g., drive time to treatment location), and are different based on an individual’s age, gender, and race/ethnicity. Using geographic availability metrics alone fails to account for other barriers and facilitators of MOUD access (e.g., insurance, stigma, access to vehicles) and thus leads to erred assessments of community’s responsiveness to OUD treatment needs. The patient-centered access to healthcare framework organizes individual and structural level factors impacting access into five stages including the opportunity to (i) identify healthcare needs, and then (ii) seek, (iii) reach, (iv) obtain, and (v) use the appropriate health care services. The overarching goal of our study is to improve receipt of opioid treatment cascade services via data- driven tailoring and monitoring of services. The primary objective is to develop and validate a replicable and scalable Small Area Multidimensional MOUD Access (SAMMA) suite of measures along with computing dashboards to enable dissemination. The rationale for this proposal is that embedding a multidimensional, patient-centered framework of MOUD access within a socio-ecological view of health should facilitate improved understanding of community variation in the opioid treatment cascade and enable a more sophisticated tailoring and monitoring of interventions. The primary objective will involve three specific aims: 1) create a suite of SAMMA measures within 50 US states and the District of Columbia; 2) validate and refine the SAMMA measures on the community level; and 3) validate and refine the SAMMA measures by exploring access within small areas where individual level access diverges from the SAMMA measures. For Aim 1, we will engage with governmental health agencies and key community partners to create the SAMMA measures using publicly- available, community level data including the American Community Survey. For Aim 2, we will validate and refine the SAMMA measures with community level Medicaid claims data, MOUD availability data, and the Centers for Disease Control and Prevention Social Vulnerability Index. For Aim 3, we will employ a mixed- method convergent parallel approach using multi-location surveys of people who use drugs (PWUD) to measure bivariate and multilevel model associations of individual level access and the SAMMA measures and conduct semi-structured interviews among PWUD who’s individual level access diverged from the SAMMA measures. Our innovative study will be the first to integrate multiple stages of healthcare access into a community MOUD access measure by engaging key partners during development. It has potential for high impact actionable insights, as we will leverage data science to better localize and monitor responses for OUD treatment by developing a replicable and scalable suite of SAMMA measures.

PROJECT NARRATIVE The proposed research is relevant to public health because of the ongoing rise in opioid overdose deaths across urban and rural communities and the known racial and geographic inequities in access to medications for opioid use disorder. Increasing the receipt of and equity in services across the opioid treatment cascade to reduce opioid harms is a priority of the National Institute on Drug Abuse. Leveraging data science to better localize and monitor responses for OUD treatment by developing a replicable and scalable Small Area Multidimensional suite of measures of medication access will inform organizational-, community-, and system- level interventions to improve receipt of services across the opioid treatment cascade.