Background: The opioid crisis continues to impact the US public health arena. The increasing rates of drug overdoses have resulted in higher demand and need for access to medication for opioid use disorder (OUD), including methadone. Methadone is only accessible through opioid treatment programs (OTPs) and affiliated medication units. Furthermore, in Tennessee, opioid-related deaths increased by 54% from 2019 to 2020, with 18% occurring in rural counties. This study aims to identify obstacles to methadone access for OUD within Tennessee.

Methods: Data from the Tennessee Department of Mental Health and Substance Abuse Services, Tennessee Department of Health, and the 2020 Census was analyzed. Descriptive statistics were used in determining the accessibility and feasibility of methadone for OUD within Tennessee.

Results: Tennessee has 22 OTPs distributed across 11 urban and four rural counties. Individuals in rural counties are 2.66 times less likely to have access to an OTP than individuals in urban counties. Proximity to an OTP, medication take-home policy, and hours of operation was identified as barriers to access. Tennessee has 2297 pharmacies: 24.8% in rural and 75.2% in urban counties. Individuals in rural areas are twice as likely to have access to a pharmacy than an OTP.

Conclusion: The disproportionate distribution of OTPs has contributed to gaps in care for OUD in rural counties. In addition, proximity to OTP or pharmacies contributes to exacerbated or reduced barriers to methadone access. Therefore, establishing medication units in collaboration with pharmacies in underserved areas is a viable solution to increase access.