Study Shows Treatment Disparities for Vulnerable VA Patient Populations with Opioid Use Disorder

BACKGROUND:
Medications are the most effective treatments for opioid use disorder (OUD), with strong evidence supporting methadone and buprenorphine as first-line medications and naltrexone as a second-line medication. However, these medications are under-used and some populations may face heightened challenges accessing medications for OUD. This study examined the association between vulnerable populations, facility characteristics, and receipt of medications for OUD. Using VA data, investigators identified all Veterans (n=53,568) who received care at VA facilities or care that was paid for by VA, in FY2017, and who were diagnosed with OUD. Within this cohort, six vulnerable populations were defined: women (n=3,814), Veterans age 35 and older (n=42,999), Veterans from racial/ethnic minority groups (n=14,593), Veterans who lived in rural areas (n=15,466), homeless Veterans (n=22,982), and justice-involved Veterans (n=7,672). In addition to assessing the prevalence of OUD, receipt of medications to treat OUD, and facility characteristics, investigators examined covariates that included marital status, service-connected disability rating, and comorbid psychiatric and/or substance use disorders.

FINDINGS:

• Since the last national study of VA patients (using FY2012 data), the prevalence of receipt of medications for OUD increased overall from 33% to 41%; however, vulnerable patient populations – including women, older, Black, rural, homeless, and justice-involved Veterans – had lower odds of receiving medications for OUD than their non-vulnerable counterparts.
• Veterans had higher odds of receiving medications at facilities with a higher proportion of patients with OUD, and lower odds of receiving medications at facilities in the Southern region of the United States compared to the Northeast.
• The prevalence of OUD was notably higher among homeless compared to housed Veterans (10% vs 2%), and justice-involved compared to non-justice-involved Veterans (10% vs 2%).

IMPLICATIONS:

• Findings suggest it may be necessary to monitor vulnerable populations to ensure that they receive the same quality of care as other VA patient populations.

LIMITATIONS:

• This study sample only included Veterans with an OUD diagnosis in their electronic health record. There may be vulnerable populations within VA that are under- or over-diagnosed for OUD.
• Veterans who received medications outside VA and that were not paid for by VA may have been missed, and pharmacy records did not allow investigators to determine whether patients used medications as directed.

AUTHOR/FUNDING INFORMATION:
Dr. Finlay was supported by an HSR&D Career Development Award; Drs. Harris and Timko are supported by HSR&D Senior Research Career Scientist Awards. Drs. Finlay, Harris, and Timko are part of HSR&D’s Center for Innovation to Implementation (Ci2i) in Palo Alto, CA.

Finlay A, Harris A, Timko C, et al. Disparities in Access to Medications for Opioid Use Disorder in the Veterans Health Administration. Journal of Addiction Medicine. August 18, 2020;epub ahead of print.