TY - JOUR
T1 - Medications for opioid use disorder in the Department of Veterans Affairs (VA) health care system
T2 - Historical perspective, lessons learned, and next steps
AU - Wyse, Jessica J.
AU - Gordon, Adam J.
AU - Dobscha, Steven K.
AU - Morasco, Benjamin J.
AU - Tiffany, Elizabeth
AU - Drexler, Karen
AU - Sandbrink, Friedhelm
AU - Lovejoy, Travis I.
N1 - Funding Information:
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. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Publisher Copyright:
©, This work was authored as part of the Contributor's official duties as an Employee of the United States Government and is therefore a work of the United States Government. In accordance with 17 U.S.C. 105, no copyright protection is available for such works under U.S. Law.
PY - 2018/4/3
Y1 - 2018/4/3
N2 - 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.
AB - 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.
KW - Veterans
KW - buprenorphine
KW - opioid use disorder
KW - pharmacotherapy
UR - http://www.scopus.com/inward/record.url?scp=85053481395&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85053481395&partnerID=8YFLogxK
U2 - 10.1080/08897077.2018.1452327
DO - 10.1080/08897077.2018.1452327
M3 - Comment/debate
C2 - 29595375
AN - SCOPUS:85053481395
VL - 39
SP - 139
EP - 144
JO - Substance Abuse
JF - Substance Abuse
SN - 0889-7077
IS - 2
ER -