Hindawi Publishing Corporation Journal of Environmental and Public Health Volume 2011, Article ID 948789, 10 pages doi:10.1155/2011/948789 Research Article Distance Traveled and Cross-State Commuting to Opioid Treatment Programs in the United States Andrew Rosenblum,1 Charles M. Cleland,1, 2 Chunki Fong,1 Deborah J. Kayman,1 Barbara Tempalski,1 and Mark Parrino3 1 National Development and Research Institutes, Inc. (NDRI), 71 W 23 Street, 8th Floor, New York, NY 10010, USA 2 College of Nursing, New York University (NYU), 726 Broadway, 10th ﬂoor, New York, NY 10003, USA 3 American Association for the Treatment of Opioid Dependence (AATOD), 225 Varick Street, 4th Floor, New York, NY 10014, USA Correspondence should be addressed to Andrew Rosenblum, rosenblum@ndri.org Received 31 December 2010; Revised 7 April 2011; Accepted 21 April 2011 Academic Editor: Pam R. Factor-Litvak Copyright © 2011 Andrew Rosenblum et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This study examined commuting patterns among 23,141 methadone patients enrolling in 84 opioid treatment programs (OTPs) in the United States. Patients completed an anonymous one-page survey. A linear mixed model analysis was used to predict distance traveled to the OTP. More than half (60%) the patients traveled <10 miles and 6% travelled between 50 and 200 miles to attend an OTP; 8% travelled across a state border to attend an OTP. In the multivariate model (n = 17, 792), factors signiﬁcantly (P < .05) associated with distance were, residing in the Southeast or Midwest, low urbanicity, area of the patient’s ZIP code, younger age, non-Hispanic white race/ethnicity, prescription opioid abuse, and no heroin use. A signiﬁcant number of OTP patients travel considerable distances to access treatment. To reduce obstacles to OTP access, policy makers and treatment providers should be alert to patients’ commuting patterns and to factors associated with them. 1. Introduction It has been well documented that geographical access is an important determinant of treatment utilization in the general population [1]. Among substance abusers longer travel distances are associated with shorter length of stay and lower probability of completion and aftercare utilization [2, 3]. Ongoing utilization (i.e., treatment retention) is especially important among methadone maintained patients because of the importance of continued medication that is often required to achieve and sustain treatment gains [4, 5]. Distance may be an especially relevant factor among methadone patients who live in rural or other areas where public transportation is limited. In addition to distance another geographical relevant factor is whether methadone patients cross state lines to attend an opioid treatment program (OTP), typically the only setting where methadone, for the treatment of opioid dependence, can be dispensed. The primary objective of the current study was to determine central tendency and variation in OTP enrollees’ travel distance between home and the treatment program. A secondary objective was to identify program and patient factors associated with travel distance. Since, to our knowl- edge, this is the ﬁrst study to describe commuting patterns among OTP enrollees, it is primarily descriptive. We did not have strong hypotheses regarding which patient or program characteristics are likely to be associated with travel distance. However, we expected that travel distance would be negatively correlated with urbanicity (since there is likely to be a higher concentration of OTPs within urban areas than nonurban areas). Also, based on ﬁndings from our previous study of OTP enrollees [6] we expected that factors associated with low urbanicity such as prescription opioid abuse, white race, employment, and ﬁrst methadone treatment episode would also be associated with longer travel distances. The data collection protocol for this study was conceived and executed under the auspices of the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System. The RADARS System, which was initiated through a dialogue between the Food and Drug Administration (FDA)