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|Issue 159||October 2019|
The report is a product of the VA/HSR&D Evidence Synthesis Program.
Evidence Brief: Barriers and Facilitators to Use of Medications for Opioid Use Disorder
As a component of VA’s overall response to the crisis of opioid-related morbidity and mortality, VA provides treatment for those with opioid use disorder (OUD; i.e. ICD-10 opioid dependence), a diagnosis made based on symptoms (i.e., drug cravings) and behaviors (i.e., inability to cut down or control substance use despite knowledge of clear negative substance-related consequences). Methadone, buprenorphine, and extended-release naltrexone are approved by the Federal Drug Administration (FDA) for treatment of OUD. However, these medications are underutilized within the VA healthcare system and the general community despite evidence of their effectiveness – and guidelines from VA/DoD recommending them as an option for first-line treatment for OUD. Reasons for underutilization of OUD medications are likely due to multiple interconnected factors at the patient, provider, and systems levels. The aim of this rapid review was to synthesize the evidence on barriers and facilitators at each of these levels to help inform VA stakeholders engaged in policy development, program planning, and OUD research.
Investigators with VA’s Evidence Synthesis Program in Portland, OR searched MEDLINE, PsycINFO, CENTRAL, Cochrane Database of Systematic Reviews, and EMBASE from inception through March 2019; additional citations were identified from hand-searching reference lists and consultation with content experts. The review focused on buprenorphine and extended-release naltrexone, which can be prescribed in office-based settings (rather than methadone which is only prescribed in specialized treatment programs) and have the most potential for widespread use. The review also was limited to articles published since 2014 in order to focus on evidence in the context of recent VA and federal policy changes. Among nearly 3,000 potentially relevant citations, investigators included 26 studies published since 2014; of these, they prioritized evidence synthesis of 16 studies that were most applicable to VA. All studies discussed buprenorphine/naloxone, while only one discussed extended-release naltrexone.
Summary of Findings
Further, no studies of systems-level barriers with applicability to VA settings were identified, and no studies directly evaluated whether barriers and facilitators vary by patient or provider characteristics or setting.
Implications for Current Practice and Policy
Related HSR&D Research Topics:
Please feel free to forward this information to others!
ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.
This Management e-Brief is provided to inform you about recent HSR&D findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR&D Resource Center charged with disseminating important HSR&D findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.
This report is a product of VA/HSR&D's Evidence Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers –; and to disseminate these reports throughout VA.
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