Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government
Veterans Benefits and Health Care About VA Find a VA Location

VA Health Systems Research

Go to the VA ORD website
Go to the QUERI website

CDA 18-193 – HSR Study

 
CDA 18-193
Expanding access to opioid use disorder treatment with buprenorphine in rural primary care settings
Jessica J. Wyse, PhD MA MPP
VA Portland Health Care System, Portland, OR
Portland, OR
Funding Period: July 2020 - June 2025

Abstract

Background: Opioid use disorder (OUD) affects a significant number of VA patients, and has serious consequences, including overdose and death. While medication is recognized as the most effective treatment for OUD, it remains under-utilized within VA. This is particularly true for rural patients, who are 37% less likely to receive a medication for OUD than Veterans residing in urban areas. Addressing the rural disparity in access to medication has become increasingly important as rural areas have been disproportionately impacted by the consequences of the opioid crisis, including opioid-related mortality. Significance/Impact: Enhancing access to medication for OUD for all Veterans is a major priority within VA. The research proposed will address a substantial disparity in health care access for rural Veterans, and has the potential to positively impact thousands of rural Veterans with OUD who currently lack access to evidence- based OUD treatment. Innovation: The proposed research leverages the knowledge and experience of rural facilities that have been successful in integrating buprenorphine into primary care to inform the design of an implementation strategy to support rural, primary care buprenorphine treatment. Specific Aims: Aim 1: Characterize a) VA facilities’ rates of primary care buprenorphine prescribing over time and b) differences in primary care-based buprenorphine prescribing for rural versus urban Veterans. Aim 2) Among rural facilities with improved primary care based buprenorphine prescribing, qualitatively explore implementation strategies utilized, facilitators to success, and methods to overcome implementation barriers. Aim 3) Develop and pilot test an implementation strategy to facilitate the initiation and scale-up of buprenorphine prescribing in rural CBOCs within one VA facility. Methodology: This study utilizes a mixed methods sequential explanatory design, in which findings from each Aim inform the design and conduct of subsequent Aims, which themselves contextualize and elaborate upon initial findings. Aim 1 is a retrospective cohort study utilizing national VA data. Aim 2 utilizes qualitative interviews with a sample of clinical administrators and direct care providers embedded within rural facilities that have improved their rate of primary care-based buprenorphine prescribing over time. Aim 3 is a pilot trial of the implementation strategy that will be evaluated via formative evaluation methods. Next Steps/Implementation: The Aim 3 pilot will inform IIR #2 in year 5 of the CDA, which will be a multi- center trial of the implementation strategy within rural CBOCs of VISN 20, comprising Alaska, Washington, Oregon, and Idaho—states with a considerable number of rural primary care locations.

External Links for this Project

NIH Reporter

Grant Number: IK2HX003007-01A1
Link: https://reporter.nih.gov/project-details/9953385


Dimensions for VA

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

Learn more about Dimensions for VA.

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.     Search Dimensions for this project

PUBLICATIONS:


Journal Articles

  1. Wyse J, Simmons A, Ramachandran B, Dobscha SK, Morasco BJ. "I Don't Mind Doing What It Takes to be Safe." Patient Perspectives of Urine Drug Testing for Pain. Journal of general internal medicine. 2021 Jan 1; 36(1):243-244. [view]
  2. Wyse JJ, Lovejoy TI, Gordon AJ, Mackey K, Herreid-O'Neill A, Morasco BJ. "I'm Clean and Sober, But Not Necessarily Free": Perceptions of Buprenorphine Among Patients in Long-Term Treatment. Substance Abuse. 2023 May 3; 44(1):41-50. [view]
  3. Eckhardt A, Waller DE, Shull S, Lovejoy TI, Morasco BJ, Gordon AJ, Wyse JJ. "They Ask Questions, But They Don't Want the Answers"-Perceptions of Clinical Communication Among Veterans Discontinuing Buprenorphine for the Treatment of Opioid Use Disorder. Substance use & addiction journal. 2024 May 20; 29767342241251761. [view]
  4. Wyse JJ, Shull S, Lindner S, Morasco BJ, Gordon AJ, Carlson KF, Korthuis PT, Ono SS, Liberto JG, Lovejoy TI. Access to Medications for Opioid Use Disorder in Rural Versus Urban Veterans Health Administration Facilities. Journal of general internal medicine. 2023 Jun 1; 38(8):1871-1876. [view]
  5. Wyse JJ, Morasco BJ, Dougherty J, Edwards B, Kansagara D, Gordon AJ, Korthuis PT, Tuepker A, Lindner S, Mackey K, Williams B, Herreid-O'Neill A, Paynter R, Lovejoy TI. Adjunct interventions to standard medical management of buprenorphine in outpatient settings: A systematic review of the evidence. Drug and Alcohol Dependence. 2021 Nov 1; 228:108923. [view]
  6. Gordon AJ, Saxon AJ, Kertesz S, Wyse JJ, Manhapra A, Lin LA, Chen W, Hansen J, Pinnell D, Huynh T, Baylis JD, Cunningham FE, Ghitza UE, Bart G, Yu H, Sauer BC. Buprenorphine use and courses of care for opioid use disorder treatment within the Veterans Health Administration. Drug and Alcohol Dependence. 2023 Jul 1; 248:109902. [view]
  7. Wyse JJ, Mackey K, Lovejoy TI, Kansagara D, Tuepker A, Gordon AJ, Todd Korthuis P, Herreid-O'Neill A, Williams B, Morasco BJ. Expanding access to medications for opioid use disorder through locally-initiated implementation. Addiction science & clinical practice. 2022 Jun 20; 17(1):32. [view]
  8. Kennedy AJ, McGinnis KA, Merlin JS, Edelman EJ, Gordon AJ, Korthuis PT, Skanderson M, Williams EC, Wyse J, Oldfield B, Bryant K, Justice A, Fiellin DA, Kraemer KL. Impact of intensity of behavioral treatment, with or without medication treatment, for opioid use disorder on HIV outcomes in persons with HIV. Journal of substance abuse treatment. 2022 Jan 1; 132:108509. [view]
  9. Wyse JJ, Mackey K, Kauzlarich KA, Morasco BJ, Carlson KF, Gordon AJ, Korthuis PT, Eckhardt A, Newell S, Ono SS, Lovejoy TI. Improving access to buprenorphine for rural veterans in a learning health care system. Health services research. 2024 Jul 2. [view]
  10. Wyse JJ, Eckhardt A, Newell S, Gordon AJ, Morasco BJ, Carlson K, Korthuis PT, Ono SS, Lovejoy TI. Integrating Buprenorphine for Opioid Use Disorder into Rural, Primary Care Settings. Journal of general internal medicine. 2024 Sep 1; 39(12):2142-2149. [view]
  11. Wyse JJ, Lovejoy J, Holloway J, Morasco BJ, Dobscha SK, Hagedorn H, Lovejoy TI. Patients' perceptions of the pathways linking chronic pain with problematic substance use. Pain. 2021 Mar 1; 162(3):787-793. [view]
  12. Wyse JJ, Eckhardt A, Waller D, Gordon AJ, Shull S, Lovejoy TI, Mackey K, Morasco BJ. Patients' Perspectives on Discontinuing Buprenorphine for the Treatment of Opioid Use Disorder. Journal of addiction medicine. 2024 May 1; 18(3):300-305. [view]
  13. Somohano V, Vasquez A, Shank T, Irrgang M, Newman AG, Evans C, Wyse JJ, Denneson LM, O'Neil ME, Lovejoy TI. Perceptions of women with comorbid PTSD and SUD on mechanisms underlying mindfulness-based interventions. Cognitive and behavioral practice. 2024 Feb 1; 31(1):https://doi.org/10.1016/j.cbpra.2022.05.003. [view]
  14. Wyse JJ, Herreid-O'Neill A, Dougherty J, Shull S, Mackey K, Priest KC, Englander H, Thoma J, Lovejoy TI. Perioperative Management of Buprenorphine/Naloxone in a Large, National Health Care System: a Retrospective Cohort Study. Journal of general internal medicine. 2022 Sep 1; 37(12):2998-3004. [view]
  15. Wyse JJ, McGinnis KA, Edelman EJ, Gordon AJ, Manhapra A, Fiellin DA, Moore BA, Korthuis PT, Kennedy AJ, Oldfield BJ, Gaither JR, Gordon KS, Skanderson M, Barry DT, Bryant K, Crystal S, Justice AC, Kraemer KL. Twelve-Month Retention in Opioid Agonist Treatment for Opioid Use Disorder Among Patients With and Without HIV. AIDS and behavior. 2022 Mar 1; 26(3):975-985. [view]


DRA: Substance Use Disorders, Health Systems Science
DRE: TRL - Applied/Translational
Keywords: Career Development, Substance Use and Abuse
MeSH Terms: None at this time.

Questions about the HSR website? Email the Web Team

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.