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Author Notes:

Correspondence: Jessica J. Wyse, PhD, MPP, jessica.wysse@va.gov, VA Portland Health Care System, 3710 SW US Veterans Hospital Road, Portland, OR 97239, USA.

Author contributions: Drs. Wyse, Gordon, Dobscha, Morasco, Tiffany, Drexler, Sandbrink, and Lovejoy all contributed to the paper’s conceptualization. Dr. Wyse drafted the manuscript. Drs. Drexler, Gordon, Sandbrink, and Tiffany contributed key data. All authors contributed to critical revision of the manuscript.

Acknowledgements: We would like to thank Ilse Wiechers, MD, MPP, MHS, Melisa Christopher, PharmD, and Mitchell Nazario, PharmD, for sharing expert knowledge in contribution to this paper. We also thank Julia Holloway for excellent research assistance.

Subjects:

Research Funding:

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).

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.

Keywords:

  • Veterans
  • buprenorphine
  • opioid use disorder
  • pharmacotherapy
  • Analgesics, Opioid
  • Capacity Building
  • Forecasting
  • Guidelines as Topic
  • Health Policy
  • Health Services Accessibility
  • History, 20th Century
  • History, 21st Century
  • Humans
  • Opiate Substitution Treatment
  • Opioid-Related Disorders
  • United States
  • United States Department of Veterans Affairs

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

Tools:

Journal Title:

Substance Abuse

Volume:

Volume 39, Number 2

Publisher:

, Pages 139-144

Type of Work:

Article | Post-print: After Peer Review

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.

Copyright information:

© 2018 Informa UK Limited.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/rdf).
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