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Receipt of pharmacotherapy for opioid use disorder: Comparing Veterans in Veterans Justice Programs with other Veterans

Finlay AK, Harris A, Blue-Howells J, Rosenthal J, McGuire J, Binswanger I. Receipt of pharmacotherapy for opioid use disorder: Comparing Veterans in Veterans Justice Programs with other Veterans. Poster session presented at: AcademyHealth Annual Research Meeting; 2015 Jun 14; Minneapolis, MN.




Abstract:

Research Objective: Among formerly incarcerated adults, overdose is the leading cause of death within 10 years of release, with opioids involved in 59% of overdose deaths. Veterans Health Administration (VHA) Health Care for Reentry Veterans and Veterans Justice Outreach (VJO) programs provide outreach to Veterans in prison, jails, courts and other criminal justice system settings in order to link them with VHA services to treat substance use disorders (SUDs), including opioid use disorder (OUD). Although some work has been conducted on the prevalence of SUDs among Veterans, limited research has examined SUD treatment patterns, especially use of pharmacotherapy. We will present the results from a national study of receipt of pharmacotherapy for opioid use disorder among Veterans who have contact with the HCRV or VJO programs. We determined receipt of pharmacotherapy for opioid use disorder among Veterans with OUD served through HCRV or VJO compared with other Veterans with OUD not in these programs. Study Design: Using national VHA outpatient clinical/administrative records, we conducted a retrospective cohort study of Veterans who received an OUD diagnosis (ICD-9-CM codes 304.0x, 304.7x, or 305.5x) in fiscal year 2012 (October 1, 2011 through September 30, 2012). Outpatient and pharmacy clinical/administrative records were examined for the one-year period following diagnosis. Receiptof pharmacotherapy for opioid use disorder was defined as receiving at least one prescription for methadone, buprenorphine, and naltrexone during the one-year period. Using a mixed-effects logistic regression model, we modeled the odds of a Veteran receiving opioid medication as a function of contact with the HCRV or VJO programs, adjusting for demographic (e.g., gender, age, race) and facility (e.g., weekend service hours, wait period) characteristics. Population Studied: All Veterans seen at a VHA facility who received an OUD diagnosis in fiscal year 2012, compared by HCRV (n = 1,245) or VJO (n = 3,972) program contact or other (n = 48,168) status. Principal Findings: There were 174 (14%) Veterans in HCRV and 895 (23%) Veterans in VJO who received pharmacotherapy for OUD, compared to 11,671 (24%) other Veterans. HCRV Veterans had 0.64 lower adjusted odds (95% confidence interval [CI]: 0.54-0.76) and VJO Veterans had 0.82 lower adjusted odds (95% CI: 0.76-0.90) of receiving pharmacotherapy for OUD compared to other Veterans. Conclusions: Formerly incarcerated or otherwise justice involved Veterans may be facing additional barriers to accessing pharmacotherapy for opioid use disorder compared to other Veterans, though overall access to these medications could be increased for all Veterans with OUD. Implications for Policy or Practice: Given the high risk for overdose among justice-involved populations, ensuring their access rates are at least equivalent to other Veterans is crucial. Strengthening links between the justice system and VHA and educating HCRV and VJO Specialists about the importance of assessing for opioid use disorder and communicating the benefits of pharmacotherapy for OUD may help increase use of these medications.





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