Abstract

Impacts: The proposed research addresses a critical VHA and HSR&D priority to improve access to opioid use disorder (OUD) treatment by developing and pilot testing a novel telehealth treatment delivery intervention. Background: With the national opioid epidemic, OUD prevalence in Veterans has increased and many Veterans with OUD experience serious and preventable harms including overdose and suicide. Increasing access to treatment, especially with the medication buprenorphine, can help prevent these harms. However, only a third of Veterans with OUD receive evidence-based treatment. The biggest access barrier is lack of trained buprenorphine providers on-site across VHA facilities, contributing to particularly low treatment for Veterans receiving care in Community-Based Outpatient Clinics (CBOCs). Telehealth interventions have been developed in the VA to allow specialists in VA Medical Centers to deliver treatment to Veterans in CBOCs, but minimal research has been done on telehealth for substance use disorders. A few VA facilities, including the VA Ann Arbor Healthcare System have begun to use telehealth to deliver OUD treatment, but research is needed to inform a telehealth model that can be scalable across facilities, examine impact on treatment use, and determine where telehealth should be targeted to maximize impact. The methods and sequence have been designed to address these pressing questions in the following 3 aims: Aim 1: Semi-structured interviews will be conducted with patients and clinicians in four facilities, including the VA Ann Arbor Healthcare System, that have begun to use telehealth delivery of OUD treatment to Veterans in CBOCs, to understand components of their interventions, perceptions of treatment and barriers and facilitators to use. Informed by these qualitative findings, a Delphi panel of OUD experts, including frontline providers, will help refine a telehealth intervention that can be feasible across facilities and will be pilot tested in Aim 2. Aim 2: In a pilot trial, CBOC Veterans with OUD will be randomized to the telehealth OUD intervention refined in Aim 1 (n=20) or in-person OUD treatment as usual (n=20). The study will examine feasibility and acceptability incorporating survey data and qualitative interviews with participants and study clinicians and characterize treatment engagement, retention and substance-use outcomes over 3 month followup. Aim 3: Using national VHA data of CBOC Veterans with OUD, analyses will examine factors associated with patient and facility-level variation in OUD treatment to understand areas where treatment is need. Analyses will also examine facility level variation in buprenorphine provider capacity and telehealth use. These findings will identify key patient and facility-level factors associated with treatment need and indicate which patients and CBOCs should be prioritized for telehealth. Candidate: The PI's long-term goal is to build on her addiction clinical and research background to become a leading VA health services researcher developing and evaluating interventions to improve treatment and outcomes for Veterans with OUD and other substance use disorders. The PI will gain training in: 1) mixed methods, 2) randomized intervention trials, 3) implementation science and 4) multi-level modeling. With a stellar mentorship team and key operational partners, the research and training in this CDA will allow her to launch a long trajectory of research developing and evaluating effective and accessible interventions to improve outcomes for Veterans with OUD and other substance use disorders.

NIH Reporter Project Information: https://reporter.nih.gov/project-details/9719031


PUBLICATIONS:

Journal Articles

1. Powell VD, Macleod C, Sussman J, Lin LA, Bohnert ASB, Lagisetty P. Variation in Clinical Characteristics and Longitudinal Outcomes in Individuals with Opioid Use Disorder Diagnosis Codes. Journal of general internal medicine. 2023 Feb 1; 38(3):699-706.
2. Lin LA, Powell VD, Macleod C, Bohnert ASB, Lagisetty P. Factors associated with clinician treatment recommendations for patients with a new diagnosis of opioid use disorder. Journal of substance abuse treatment. 2022 Oct 1; 141:108827.
3. Vitzthum LK, Nalawade V, Riviere P, Marar M, Furnish T, Lin LA, Thompson R, Murphy JD. Impacts of an Opioid Safety Initiative on US Veterans Undergoing Cancer Treatment. Journal of the National Cancer Institute. 2022 May 9; 114(5):753-760.
4. Bicket MC, Lin LA, Waljee J. New Persistent Opioid Use After Surgery: A Risk Factor for Opioid Use Disorder? Annals of surgery. 2022 Feb 1; 275(2):e288-e289.
5. Frank CJ, Lin LA. Defining and supporting high-quality telehealth for patients with opioid use disorder: The promise and potential pitfalls of telehealth expansion. Substance Abuse. 2022 Jan 1; 43(1):1370-1373.
6. Lin LA, Bonar EE, Zhang L, Girard R, Coughlin LN. Alcohol-involved overdose deaths in US veterans. Drug and Alcohol Dependence. 2022 Jan 1; 230:109196.
7. Coughlin LN, Zhang L, Bohnert ASB, Maust DT, Goldstick J, Lin LA. Patient characteristics and treatment utilization in fatal stimulant-involved overdoses in the United States Veterans Health Administration. Addiction (Abingdon, England). 2022 Apr 1; 117(4):998-1008.
8. Fernandez AC, Lin LA, Bazzi AR, Boissoneault J, Borsari B, Blow F. Beliefs About Perioperative Opioid and Alcohol Use among Elective Surgical Patients Who Report Unhealthy Drinking: A Qualitative Study. Pain medicine (Malden, Mass.). 2021 Oct 8; 22(10):2384-2392.
9. Coughlin LN, Lin LA, Jannausch M, Ilgen MA, Bonar EE. Methamphetamine use among American Indians and Alaska Natives in the United States. Drug and Alcohol Dependence. 2021 Oct 1; 227:108921.
10. Lin LA, Fortney JC, Bohnert ASB, Coughlin LN, Zhang L, Piette JD. Comparing telemedicine to in-person buprenorphine treatment in U.S. veterans with opioid use disorder. Journal of substance abuse treatment. 2022 Feb 1; 133:108492.
11. Lagisetty P, Garpestad C, Larkin A, Macleod C, Antoku D, Slat S, Thomas J, Powell V, Bohnert ASB, Lin LA. Identifying individuals with opioid use disorder: Validity of International Classification of Diseases diagnostic codes for opioid use, dependence and abuse. Drug and Alcohol Dependence. 2021 Apr 1; 221:108583.
12. Bohnert ASB, Lin LA. It is time to recognize that synthetic opioids are not going away. Addiction (Abingdon, England). 2021 Jun 1; 116(6):1316-1317.
13. Becker WC, Krebs EE, Edmond SN, Lin LA, Sullivan MD, Weiss RD, Gordon AJ. A Research Agenda for Advancing Strategies to Improve Opioid Safety: Findings from a VHA State of the Art Conference. Journal of general internal medicine. 2020 Dec 1; 35(Suppl 3):978-982.
14. Coughlin LN, Pfeiffer P, Ganoczy D, Lin LA. Quality of Outpatient Depression Treatment in Patients With Comorbid Substance Use Disorder. The American journal of psychiatry. 2021 May 1; 178(5):414-423.
15. Lin LA, Bohnert ASB, Blow FC, Gordon AJ, Ignacio RV, Kim HM, Ilgen MA. Polysubstance use and association with opioid use disorder treatment in the US Veterans Health Administration. Addiction (Abingdon, England). 2021 Jan 1; 116(1):96-104.