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Reichert J, Adams S, Taylor J, del Pozo B. Guiding officers to deflect citizens to treatment: an examination of police department policies in Illinois. HEALTH & JUSTICE 2023; 11:7. [PMID: 36750519 PMCID: PMC9906953 DOI: 10.1186/s40352-023-00207-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 01/17/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND The U.S. overdose crisis has motivated police departments to enact policies allowing officers to directly deflect individuals to substance use disorder treatment and other services shown to reduce recidivism and subsequent overdose risk, as well as refer people who voluntarily present at police facilities with a desire for treatment. As a new way of operating, and one that relies on an officer's use of discretion for successful implementation, the practice benefits from guidance through written directives, training, and supervisory support. However, there is little information on the establishment, content, and execution of police department deflection policies, which hampers the implementation and dissemination of this promising practice. We analyzed 16 policies of Illinois police department deflection programs. Using content analysis methodology, we coded the policies for language and terminology, as well as program components and procedures. We aimed to examine how the policies were written, as well as the content intending to guide officers in their work. RESULTS We found the policies and programs had notable differences in length, detail, terminology, and reading level. Only one policy mentioned the use of any type of addiction treatment medication, many used stigmatizing language (e.g., "abuse" and "addict"), and few mentioned "harm reduction" or training in the practice of deflection. Many policies restricted participation in deflection (i.e., no minors, outstanding warrants, current withdrawal symptoms), and critically, a majority of policies allowed police officers to exclude people from participation based on their own judgment. CONCLUSIONS We recommend police departments consider the readability of their policies and reduce barriers to deflection program participation to engage a larger pool of citizens in need of substance use disorder treatment. Since there is limited research on police policies generally, and the field of deflection is relatively new, this study offers insight into the content of different department policies and more specifically, how officers are directed to operate deflection programs.
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Affiliation(s)
- Jessica Reichert
- Center for Justice Research and Evaluation, Illinois Criminal Justice Information Authority, 60 E. Van Buren St., Suite 650, Chicago, IL 60605 USA
| | - Sharyn Adams
- Center for Justice Research and Evaluation, Illinois Criminal Justice Information Authority, 60 E. Van Buren St., Suite 650, Chicago, IL 60605 USA
| | - Jirka Taylor
- RAND Corporation, 1200 S Hayes St, Arlington, VA 22202 USA
| | - Brandon del Pozo
- The Warren Alpert Medical School of Brown University, 593 Eddy Street, Providence, RI 02903 USA
- Rhode Island Hospital, 593 Eddy Street, 02903 Providence, USA
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Dowd WN, Barch DH, Seibert JH, Mark TL. Development and validation of a claim-based provider-level measurement of use of medications to treat opioid use disorder. J Subst Abuse Treat 2022; 140:108824. [DOI: 10.1016/j.jsat.2022.108824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/28/2022] [Accepted: 06/07/2022] [Indexed: 11/25/2022]
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Taylor EN, Timko C, Binswanger IA, Harris AHS, Stimmel M, Smelson D, Finlay AK. A national survey of barriers and facilitators to medications for opioid use disorder among legal-involved veterans in the Veterans Health Administration. Subst Abus 2022; 43:556-563. [PMID: 34586978 PMCID: PMC9423124 DOI: 10.1080/08897077.2021.1975867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background: Medications for opioid use disorder (MOUD) are clinically effective at treating OUD among legal-involved populations. However, research shows that legal-involved veterans who receive care through the VHA have lower rates of MOUD use compared to non-legal-involved veterans. Education may be a key factor in intervention strategies to improve MOUD access. This study was a national survey of VHA staff to identify barriers to and facilitators of MOUD, as well as MOUD-related education needs for VHA staff, community partners, criminal justice partners, and legal-involved veterans. Method: A 98-item online survey was conducted to examine VHA staff perspectives (N = 218) around needed education, barriers to, and facilitators of MOUD for legal-involved veterans. Descriptive statistics were conducted and linear regression analyses were used to evaluate differences in perceptions by respondents' current position at the VHA and their VHA facility's rate of provision of MOUD among legal-involved veterans. Results: Respondents endorsed a need for education in all areas of MOUD (e.g., existing medications for the treatment of OUD) for VHA staff and providers, community partners, criminal justice partners, and legal-involved veterans. VHA staff perceived barriers to MOUD for legal-involved veterans to include stigma and complicated guidelines around MOUD and OUD treatment. Facilities with low rates of MOUD use highlighted barriers including MOUD conflicting with the philosophy of the local VHA facility and provider stigma toward patients with OUD. Perceptions of efficacy of MOUD differed by respondents' current position at the VHA such that substance use disorder treatment providers perceived buprenorphine and methadone as more effective compared to Veterans Justice Specialists. Conclusion: The results of this study suggest a need for an educational intervention emphasizing the evidence supporting use of MOUD as a lack of knowledge about these medications was considered a barrier to access, whereas gaining education about MOUD was a facilitator to access. Education strategies specifically tailored to address VHA facility-level differences may help address barriers to MOUD experienced by legal-involved veterans.
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Affiliation(s)
- Emmeline N. Taylor
- U.S. Department of Veterans Affairs, VA Palo Alto Health Care System, Center for Innovation to Implementation, Palo Alto, CA, USA,Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, CO, USA
| | - Christine Timko
- U.S. Department of Veterans Affairs, VA Palo Alto Health Care System, Center for Innovation to Implementation, Palo Alto, CA, USA,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Ingrid A. Binswanger
- Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, USA,Colorado Permanente Medical Group, Denver, CO, USA,Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alex H. S. Harris
- U.S. Department of Veterans Affairs, VA Palo Alto Health Care System, Center for Innovation to Implementation, Palo Alto, CA, USA,Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Matthew Stimmel
- U.S. Department of Veterans Affairs, Veterans Justice Programs, Menlo Park, CA, USA
| | - David Smelson
- U.S. Department of Veterans Affairs, Edith Nourse Rodgers VA Medical Center, Center for Organization and Implementation Science, Bedford, MA, USA
| | - Andrea K. Finlay
- U.S. Department of Veterans Affairs, VA Palo Alto Health Care System, Center for Innovation to Implementation, Palo Alto, CA, USA,U.S. Department of Veterans Affairs, National Center on Homelessness Among Veterans, Menlo Park, CA, USA
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Disparities in Access to Medications for Opioid Use Disorder in the Veterans Health Administration. J Addict Med 2021; 15:143-149. [PMID: 32826617 DOI: 10.1097/adm.0000000000000719] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES A variety of patients - including women, older, racial/ethnic minority, rural, homeless, and justice-involved patients - are vulnerable to experiencing poor healthcare access and quality, such as lower quality substance use disorder treatment, than other populations. The current study examined receipt of medications for opioid use disorder by vulnerable populations within Veterans Health Administration (VHA) facilities to determine whether there are patient and facility factors that are associated with disparities in care. METHODS Using national VHA clinical/administrative data from Fiscal Year 2017, we calculated receipt of medications for opioid use disorder using the American Society for Addiction Medicine quality measure specifications. A mixed-effects logistic regression model tested whether patient vulnerability (ie, women, older age, racial/ethnic minority, rural residence, homeless, and justice-involved) and facility (eg, regional location, availability of a methadone clinic) characteristics were associated with medication receipt. RESULTS Among the 53,568 veterans at VHA facilities diagnosed with opioid use disorder in Fiscal Year 2017, vulnerable populations - including women, older, Black, rural, homeless, and justice-involved veterans - had lower odds of receiving medications for opioid use disorder than their nonvulnerable counterparts. Veterans had higher odds of receiving medications at facilities with a higher proportion of patients with opioid use disorder, but lower odds of receiving medications at facilities in the Southern region compared to the Northeast region of the United States. CONCLUSIONS Quality improvement efforts targeted at vulnerable populations are needed at the VHA to ensure these groups receive the same quality of substance use disorder treatment as other veterans.
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Morse E, Binswanger IA, Taylor E, Gray C, Stimmel M, Timko C, Harris AHS, Smelson D, Finlay AK. Strategies to improve implementation of medications for opioid use disorder reported by veterans involved in the legal system: A qualitative study. J Subst Abuse Treat 2021; 129:108353. [PMID: 34080564 DOI: 10.1016/j.jsat.2021.108353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/07/2020] [Accepted: 02/28/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Veterans involved in the legal system have a high risk of overdose mortality but limited utilization of medications for opioid use disorder (MOUD). To increase the use of MOUD in Veterans Health Administration (VHA) facilities and reduce overdose mortality, the VHA should incorporate strategies identified by legal-involved veterans to improve quality of care and ensure that their patients' experiences are integrated into care delivery. This study aims to determine strategies to increase use of MOUD from the perspective of legal-involved veterans with a history of opioid use or opioid use disorder (OUD). METHODS Between February 2018 and March 2019, we conducted semistructured interviews with 18 veterans with a history of opioid use or OUD and legal involvement (15 men and 3 women; mean age 41, standard deviation 13, range 28-61). Veterans were from 9 geographically dispersed United States VHA facilities. The study analyzed verbatim transcripts using the framework method. The primary focus was themes that represented legal-involved veteran-identified strategies to improve the use of MOUD. RESULTS The 18 veterans interviewed had legal involvement directly related to their opioid use and most (n = 15; 83%) had previously used MOUD. Veteran-identified strategies to improve access to and use of MOUD included: (1) VHA should provide transportation or telehealth services; (2) legal agencies should increase access to MOUD during incarceration; (3) the VHA should reduce physician turnover; (4) the VHA should improve physician education to deliver compassionate, patient-centered treatment; (5) the VHA should improve veteran education about MOUD; and (6) the VHA should provide social support opportunities to veterans. CONCLUSIONS Legal-involved veterans provided strategies that can inform and expand MOUD to better meet their needs and the treatment needs of all patients with OUD. The VHA should consider incorporating these strategies into care, and should evaluate their impact on patients' experience, initiation of and retention on medications, and overdose rates.
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Affiliation(s)
- Erica Morse
- Institute for Health Research, Kaiser Permanente Colorado, 10065 E Harvard Ave #300, Denver, CO 80231, USA.
| | - Ingrid A Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, 10065 E Harvard Ave #300, Denver, CO 80231, USA; Colorado Permanente Medical Group, 1835 Franklin St, Denver, CO 80218, USA; Division of General Internal Medicine, University of Colorado School of Medicine, 12631 East 17th Avenue, Aurora, CO 80045, USA.
| | - Emmeline Taylor
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; Department of Clinical Psychology, University of Colorado, 1420 Austin Bluffs Pkwy, Colorado Springs, CO 80918, USA.
| | - Caroline Gray
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA.
| | - Matthew Stimmel
- Veterans Justice Programs, U.S. Department of Veterans Affairs (MS), 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA.
| | - Christine Timko
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1199 Welch Road, Stanford, CA 94304, USA.
| | - Alex H S Harris
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; Department of Surgery, Stanford University School of Medicine, Always Building, Suite M121, 300 Pasteur Drive, Stanford, CA 94305-2200, USA.
| | - David Smelson
- Center for Organization and Implementation Science, Edith Nourse Rogers VA Medical Center, 200 Springs Road, Bedford, MA 01730, USA.
| | - Andrea K Finlay
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; National Center on Homelessness Among Veterans, Department of Veterans Affairs, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA.
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Compton WM, Wiley T, Blanco C. The Importance of Learning Health Systems in Addressing the Opioid Crisis. J Gen Intern Med 2020; 35:891-894. [PMID: 33145682 PMCID: PMC7728900 DOI: 10.1007/s11606-020-06267-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/21/2020] [Indexed: 10/23/2022]
Abstract
Interventions and research to address the US opioid crisis have, for the most part, targeted opioid use, misuse, and addiction specifically. While such a focus can lead to useful innovations in the care of opioid use disorder, the fact that many persons with opioid use disorder use multiple substances (both over their life course and simultaneously in drug-using episodes) makes it imperative to address broader issues of addiction in persons who have opioid use disorder as their presenting concern. Because of integrated care and the ability to target multiple clinical concerns in parallel, the Veterans Administration (VA) may be uniquely situated to address the key issue of multi-morbidity that persons with opioid use disorder so frequently exhibit. Research at the VA can build on new interventions developed by the National Institutes of Health (and others) and can help to determine the best ways to implement these interventions. Research at the VA does not need to duplicate efforts supported by other funders but can complement such work by providing an integrated platform for determining the best approaches to implementing innovations. The real-world learning health system that has been developed in the VA is poised to contribute in just such important ways.
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Affiliation(s)
- Wilson M Compton
- National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Service, Bethesda, MD, USA.
| | - Tisha Wiley
- National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Service, Bethesda, MD, USA
| | - Carlos Blanco
- National Institute on Drug Abuse, National Institutes of Health, U.S. Department of Health and Human Service, Bethesda, MD, USA
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Priest KC, McCarty D, Lovejoy TI. Expanding Access to Medications for Opioid Use Disorder: Program and Policy Approaches from Outside the Veterans Health Administration. J Gen Intern Med 2020; 35:886-890. [PMID: 33145685 PMCID: PMC7609303 DOI: 10.1007/s11606-020-06266-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 09/21/2020] [Indexed: 02/08/2023]
Abstract
To mitigate morbidity and mortality of the drug-related overdose crisis, the Veterans Health Administration (VHA) can increase access to treatments that save lives-medications for opioid use disorder (MOUD). Despite an increasing need, MOUD continues to be underutilized due to multifaceted barriers that exist within broader macro- and microenvironments. To promote MOUD utilization, policymakers and healthcare leaders should (1) identify and implement person-centered MOUD delivery systems (e.g., the Medication First Model, community-informed design); (2) recognize and address MOUD delivery gaps (e.g., the Best-Practice in Oral Opioid Agonist Collaborative); (3) broaden the definition of the MOUD delivery system (e.g., access to MOUD in non-clinical settings); and (4) expand MOUD options (e.g., injectable opioid agonist therapy). Increasing access to MOUD is not a singular fix to the overdose-related crisis. It is, however, a possible first step to mitigate harm, and save lives.
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Affiliation(s)
- Kelsey C Priest
- School of Medicine, MD/PhD Program, Oregon Health & Science University, Portland, OR, USA.
| | - Dennis McCarty
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
| | - Travis I Lovejoy
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, USA
- Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA
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Abstract
This paper is the forty-first consecutive installment of the annual anthological review of research concerning the endogenous opioid system, summarizing articles published during 2018 that studied the behavioral effects of molecular, pharmacological and genetic manipulation of opioid peptides and receptors as well as effects of opioid/opiate agonists and antagonists. The review is subdivided into the following specific topics: molecular-biochemical effects and neurochemical localization studies of endogenous opioids and their receptors (2), the roles of these opioid peptides and receptors in pain and analgesia in animals (3) and humans (4), opioid-sensitive and opioid-insensitive effects of nonopioid analgesics (5), opioid peptide and receptor involvement in tolerance and dependence (6), stress and social status (7), learning and memory (8), eating and drinking (9), drug abuse and alcohol (10), sexual activity and hormones, pregnancy, development and endocrinology (11), mental illness and mood (12), seizures and neurologic disorders (13), electrical-related activity and neurophysiology (14), general activity and locomotion (15), gastrointestinal, renal and hepatic functions (16), cardiovascular responses (17), respiration and thermoregulation (18), and immunological responses (19).
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Affiliation(s)
- Richard J Bodnar
- Department of Psychology and Neuropsychology Doctoral Sub-Program, Queens College, City University of New York, Flushing, NY, 11367, United States.
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Finlay AK, Morse E, Stimmel M, Taylor E, Timko C, Harris AHS, Smelson D, Yu M, Blue-Howells J, Binswanger IA. Barriers to Medications for Opioid Use Disorder Among Veterans Involved in the Legal System: a Qualitative Study. J Gen Intern Med 2020; 35:2529-2536. [PMID: 32583337 PMCID: PMC7459011 DOI: 10.1007/s11606-020-05944-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Veterans involved in the legal system are at high risk for overdose but have lower receipt of medications for opioid use disorder than other veterans. OBJECTIVE The study aimed to understand barriers to medication access from the perspective of legally involved veterans with opioid use disorder and people who work with these veterans in the Veterans Health Administration (VHA) and the legal system. DESIGN This national qualitative study interviewed veterans and stakeholders from 14 geographically diverse VHA facilities to explore perceptions of barriers to medications for opioid use disorder. PARTICIPANTS Participants included veterans with a history of opioid use disorder and legal involvement (n = 18), VHA Veterans Justice Programs Specialists (n = 15), VHA and community substance use disorder treatment providers (n = 5), and criminal justice staff (n = 12). APPROACH We conducted interviews based on the Consolidated Framework for Implementation Research. Interview transcripts were analyzed using a team-based approach. KEY RESULTS Four key barriers, noted by group, were identified: (1) a preference for counseling along with or instead of medications (veterans, Specialists, treatment providers, criminal justice staff); (2) concerns about veterans using medications without a prescription, selling them, or providing them to others (veterans, Specialists, treatment providers, criminal justice staff); (3) concerns about perceived stigma towards medication use (veterans, Specialists, treatment providers, criminal justice staff); and (4) concerns about medication discontinuation after recurrent opioid use (veterans, criminal justice staff). A fifth theme, education, was noted by all stakeholders except providers as important to facilitating use of medications for opioid use disorder. All five themes mapped to the framework construct of knowledge and beliefs about the intervention. CONCLUSIONS Based on identified barriers, interventions focused on enhancing medication knowledge, reducing stigma towards use of medications, and increasing knowledge that opioid use may recur during treatment may help increase access to medication for veterans with legal involvement.
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Affiliation(s)
- Andrea K Finlay
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Road (MPD-152), Menlo Park, Willow, CA, 94025, USA. .,Department of Veterans Affairs, National Center on Homelessness Among Veterans, 795 Willow Road, Menlo Park, 94025, USA.
| | - Erica Morse
- Institute for Health Research, Kaiser Permanente Colorado, Denver, USA
| | - Matthew Stimmel
- Veterans Justice Programs, U.S. Department of Veterans Affairs, , Menlo Park, USA
| | - Emmeline Taylor
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Road (MPD-152), Menlo Park, Willow, CA, 94025, USA.,Department of Clinical Psychology, University of Colorado, Colorado Springs, Colorado Springs, USA
| | - Christine Timko
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Road (MPD-152), Menlo Park, Willow, CA, 94025, USA.,Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, USA
| | - Alex H S Harris
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Road (MPD-152), Menlo Park, Willow, CA, 94025, USA.,Department of Surgery, Stanford University School of Medicine, Stanford, USA
| | - David Smelson
- Center for Organization and Implementation Science, Edith Nourse Rogers VA Medical Center, Bedford, USA
| | - Mengfei Yu
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Road (MPD-152), Menlo Park, Willow, CA, 94025, USA
| | - Jessica Blue-Howells
- Veterans Justice Programs, U.S. Department of Veterans Affairs, , Menlo Park, USA
| | - Ingrid A Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, Denver, USA.,Colorado Permanente Medical Group, Denver, USA.,Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, USA
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Opioid Agonist Therapy During Hospitalization Within the Veterans Health Administration: a Pragmatic Retrospective Cohort Analysis. J Gen Intern Med 2020; 35:2365-2374. [PMID: 32291723 PMCID: PMC7403377 DOI: 10.1007/s11606-020-05815-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 03/20/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Hospitalization of patients with opioid use disorder (OUD) is increasing, yet little is known about opioid agonist therapy (OAT: methadone and buprenorphine) administration during admission. OBJECTIVE Describe and examine patient- and hospital-level characteristics associated with OAT receipt during hospitalization in the Veterans Health Administration (VHA). PARTICIPANTS A total of 12,407 unique patients, ≥ 18 years old, with an OUD-related ICD-10 diagnosis within 12 months prior to or during index hospitalization in fiscal year 2017 from 109 VHA hospitals in the continental U.S. MAIN MEASURE OAT received during hospitalization. KEY RESULTS Few admissions received OAT (n = 1914; 15%) and when provided it was most often for withdrawal management (n = 834; 7%). Among patients not on OAT prior to admission who survived hospitalization (n = 10,969), 2.0% (n = 203) were newly initiated on OAT with linkage to care after hospital discharge. Hospitals varied in the frequency of OAT delivery (range, 0 to 43% of qualified admissions). Patients with pre-admission OAT (adjusted odds ratio [AOR] = 15.30; 95% CI [13.2, 17.7]), acute OUD diagnosis (AOR = 2.3; 95% CI [1.99, 2.66]), and male gender (AOR 1.52; 95% CI [1.16, 2.01]) had increased odds of OAT receipt. Patients who received non-OAT opioids (AOR 0.53; 95% CI [0.46, 0.61]) or surgical procedures (AOR 0.75; 95% CI [0.57, 0.99]) had decreased odds of OAT receipt. Large-sized (AOR = 2.0; 95% CI [1.39, 3.00]) and medium-sized (AOR = 1.9; 95% CI [1.33, 2.70]) hospitals were more likely to provide OAT. CONCLUSIONS In a sample of VHA inpatient medical admissions, OAT delivery was infrequent, varied across the health system, and was associated with specific patient and hospital characteristics. Policy and educational interventions should promote hospital-based OAT delivery.
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