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

Jessica Wyse, Adam J. Gordon, Steven Dobscha, Benjamin Morasco, Elizabeth Tiffany, Karen Drexler, Friedhelm Sandbrink, Travis Lovejoy

Research output: Contribution to journalComment/debate

17 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)139-144
Number of pages6
JournalSubstance Abuse
Volume39
Issue number2
DOIs
StatePublished - Apr 3 2018

Keywords

  • buprenorphine
  • opioid use disorder
  • pharmacotherapy
  • Veterans

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health

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