The Raleigh News & Observer has been running multiple stories on the recent Medicaid expansion in North Carolina, with one recently about expanded opioid treatment coverage. Myself and Kaden Call have worked in the past on developing an algorithm to identify underprovided estimates (see background blog post, and Kaden’s work at Gainwell while an intern).

I figured I would run our algorithm through to see what North Carolina looks like. So here is an interactive map, with the top 10 zipcodes that have need for service (in red polygons), and CMS certified opioid treatment providers (in blue pins). (Below is a static image)

My initial impression was that this did not really jive with the quotes in the News & Observer article that suggested NC was a notorious service dessert – there are quite a few treatment providers across the state. So the cited Rural HealthInfo source disagrees with this. I cannot find their definition offhand, but I am assuming this is due to only counting in-patient treatment providers, whereas my list of CMS certified providers is mostly out-patient.

So although my algorithm identified various areas in the state that likely could use expanded services, this begs the question of whether NC is really a service dessert. It hinges on whether you think people need in-patient or out-patient treatment. Just a quick sampling of those providers, maybe half say they only take private, so it is possible (although not certain) that the recent Medicaid expansion will open up many treatment options to people who are dependent on opioids.

SAMHSA estimates that of those who get opioid treatment, around 5% get in-patient services. So maybe in the areas of high need I identify there is enough demand to justify opening new in-patient service centers – it is close though I am not sure the demand justifies opening more in-patient (as opposed to making it easier to access out-patient).

Asking folks with a medical background at work, it seems out-patient has proven to be as effective as in-patient, and that the biggest hurdle is to get people on buprenorphine/methadone/naltrexone (which the out-patient can do). So I am not as pessimistic as many of the health experts that are quoted in the News & Observer article.