Pharmacotherapy for Opioid Use Disorder is Highly Variable across VA Residential Substance Abuse Treatment Programs
Some Veterans with acute addiction treatment needs require more extensive services than outpatient care, such as residential programs that provide substance use disorder (SUD) treatment. Pharmacotherapy, including methadone, buprenorphine, and naltrexone, is both efficacious and cost-effective for treating opioid use disorder (OUD), however it is infrequently prescribed in VA. Investigators in this study sought to describe barriers to and facilitators of pharmacotherapy provided to a national cohort of VA patients with OUD in VA residential SUD treatment programs in FY2012 (N of Veterans = 4,323, 6% female). Electronic health record data were used to identify the Veteran cohort, and 63 staff interviews from 44 residential programs were completed from March to August 2014.
- Implementation of pharmacotherapy for OUD is highly variable across VA residential SUD treatment programs. Across all 97 treatment programs, the average rate of receipt of pharmacotherapy for OUD in FY2012 was 21% and ranged from 0% to 67%. There were 11 programs where 0% of patients received pharmacotherapy for OUD.
- Barriers included program or provider philosophy against pharmacotherapy and a lack of care coordination with non-residential treatment settings. Facilitators included education for staff and patients and having a prescriber on staff.
- Intensive educational programs, such as academic detailing, and policy changes such as mandating buprenorphine waiver training for VA providers, may help improve receipt of pharmacotherapy for OUD.
- The Office of Mental Health and Suicide Prevention has taken steps to directly address barriers identified by this study, including: requiring all mental health residential rehabilitation treatment programs to have access to a provider with the appropriate DEA x-waiver to initiate and/or continue buprenorphine; implementation of intensive educational programs; and active consultation efforts.
- Classification of treatment programs was based on FY2012 data, and interviews were conducted two years later. Therefore, these results may not accurately reflect treatment programs at the time of the interviews (2014) or currently.
- Fewer than half of residential substance use disorder treatment programs within VA were represented in this study sample.
Finlay A, Wong J, Ellerbe L, Rubinsky A, Gupta S, Bowe T, Schmidt E, Timko C, Burden J, and Sox-Harris A. Barriers and Facilitators to Implementation of Pharmacotherapy for Opioid Use Disorders in VHA Residential Treatment Programs. Journal of Studies on Alcohol and Drugs. November 2018;79(6):909-917.