Medications for opioid use disorder in the Department of Veterans Affairs (VA) health care system: Historical perspective, lessons learned, and next steps

• Type of Material: Article
• Authors: Jessica J. Wyse, Portland VA Medical Center; Adam J. Gordon, VA Medical Center; Steven K. Dobscha, Portland VA Medical Center; Benjamin J. Morasco, Portland VA Medical Center; Elizabeth Tiffany, Portland VA Medical Center; Karen Drexler, Emory University; Friedhelm Sandbrink, VA Medical Center; Travis I. Lovejoy, Portland VA Medical Center
• Language: English
• Date: 2018-04-03
• Publisher: U.S. Department of Veterans Affairs
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018 Informa UK Limited.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1080/08897077.2018.1452327
• Title of Journal or Parent Work: Substance Abuse
• Volume: 39
• Issue: 2
• Start Page: 139
• End Page: 144
• Grant/Funding Information: Dr. Lovejoy received additional support from Career Development Award IK2HX001516 from the US Department of Veterans Affairs Health Services Research and Development during preparation of the manuscript.; United States (U.S.) Department of Veterans Affairs Health Services Research & Development Center to Improve Veteran Involvement in Care at the VA Portland Health Care System Career Development Award, U.S. Department of Veterans Affairs, Health Services Research and Development; This work was supported by the US Department of Veterans Affairs Health Services Research & Development Center to Improve Veteran Involvement in Care at the VA Portland Health Care System (CIN 13-404, Principal Investigator [PI]: Dobscha).
• Keywords: Opioid-Related Disorders; Opiate Substitution Treatment; Analgesics, Opioid; Humans; United States; Guidelines as Topic; Capacity Building; pharmacotherapy; History, 21st Century; Veterans; Health Policy; opioid use disorder; United States Department of Veterans Affairs; buprenorphine; Health Services Accessibility; History, 20th Century; Forecasting
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management; Health Sciences, Epidemiology

Abstract

The US Department of Veterans Affairs (VA), the largest health care system in the US, has been confronted with the health care consequences of opioid disorder (OUD). Increasing access to quality OUD treatment, including pharmacotherapy, is a priority for the VA. We examine the history of medications (e.g., methadone, buprenorphine, injectable naltrexone) used in the treatment of OUD within VA, document early and ongoing efforts to increase access and build capacity, primarily through the use of buprenorphine, and summarize research examining barriers and facilitators to prescribing and medication receipt. We find that there has been a slow but steady increase in the use of medications for OUD and, despite system-wide mandates and directives, uneven uptake across VA facilities and within patient sub-populations, including some of those most vulnerable. We conclude with recommendations intended to support the greater use of medication for OUD in the future, both within VA as well as other large health care systems.