Reducing Overdose Deaths and Mitigating County Disparities: Optimal Allocation of Substance Use Treatment Centers.

This article focuses on optimizing the allocation of substance use disorder (SUD) treatment centers across U.S. counties to minimize overdose deaths while addressing inequity and inequality in treatment access over a multiyear horizon. Using data from over 2,500 counties between 1999 and 2016, the authors employ a predict-then-optimize framework that estimates the causal impact of treatment centers on overdose mortality—instrumented by mental health parity laws—and formulates a nonlinear program balancing three objectives: reducing statewide overdose deaths, minimizing inequity (mismatch between treatment access and overdose death rates), and minimizing inequality (mismatch between treatment access and population). Results indicate that reallocating existing treatment funding according to this model can reduce overdose deaths and disparities more effectively than current or heuristic allocation methods, with trade-offs varying by state and policy priorities. The study provides policymakers and healthcare providers with a data-driven tool to guide equitable and efficient distribution of SUD treatment resources, highlighting that prioritizing death rate reduction tends to concentrate resources in high-population counties, whereas emphasizing equity directs more resources to underserved, often low-population, areas.