Community Treatment for Opioid Use Disorders in Urban and Rural Veterans

Inequities in the treatment of opioid use disorder: A scoping review

BACKGROUND

Given the lack of access to evidenced-based OUD treatment and the corresponding overdose crisis, researchers must evaluate and report health care inequities involving the treatment of OUD. Additionally, clinicians should be aware of these inequities in the treatment of patients.

METHODS

We carried out a scoping review of the literature regarding health inequities in treatment for OUD in July 2022. The study team retrieved articles published between 2016 and 2021 from MEDLINE and Ovid Embase. After authors received training, screening and data extraction were performed in masked, duplicate fashion. The team screened a total of 3673 titles and abstracts, followed by 172 articles for full-text review. The inequities that we examined were race/ethnicity, sex or gender, income, under-resourced/rural, occupational status, education level, and LGBTQ+. We used Stata 17.0 (StataCorp, LLC, College Station, TX) to summarize data and statistics of the studies within our sample.

RESULTS

A total of 44 studies evaluating inequities in OUD treatment met inclusion criteria. The most common inequity that studies examined was race/ethnicity (34/44 [77.27 %] studies), followed by under-resourced/rural (19/44 [43.18 %] studies), and sex or gender (18/44 [40.91 %] studies). LGBTQ+ (0/44 [0.0 %] studies) was not reported in the included studies. Our results indicate that many historically marginalized populations experience inequities related to access and outcomes in OUD treatment. The included studies in our scoping review occasionally demonstrated inconsistent findings.

CONCLUSIONS

Gaps exist within the literature on health inequities in treatment for OUD. The most examined inequities were race/ethnicity, under-resourced/rural and sex or gender, while studies did not examine LGBTQ+ status. Future research should aim to advance and supplement literature investigating health inequities in OUD treatment to ensure inclusive, patient-centered care.

Behavioural health outcomes in veterans compared to nonveterans by rural and urban areas in Alabama, 2015-2018

In the United States, tobacco use, alcohol consumption and substance use disorders are more prevalent among veterans when compared to nonveterans. This is also seen in Alabama, which led the researchers to review county level data to examine possible links between substance use, mental health and suicide by veteran status. This study sought to evaluate behavioural health outcomes and impacting factors for military veterans and nonveterans living in rural and urban areas of Alabama. In phase one, we developed Alabama-specific behavioural health outcomes at the state and county level for military veterans and nonveterans. In phase two, we examined county-level correlates of behavioural health outcomes among veterans and nonveterans. The data were retrieved from the 2015-2018 National Surveys on Drug Use and Health (NSDUH) and the United States Census Bureau. Regarding tobacco use rates at the county level, nonveteran rates ranged from 23.93% to 34.56% while veteran rates ranged from 24.47% to 38.56%. Nonveteran illicit drug use rates ranged from 9.40% to 13.15% while veteran illicit drug use rates ranged from 5.50% to 10.67%. Nonveteran heavy alcohol use rates ranged from 4.54% to 7.92% while veteran heavy alcohol use rates ranged from 4.59% to 8.41%. Lastly, nonveteran suicidal ideation rates ranged from 3.64% to 4.60% while veteran suicidal ideation rates ranged from 3.16% to 4.51%. Veterans have a significantly higher potential of having suicidal ideations. We showed that illicit drug use and suicidal ideation have increased in Alabama among veterans and nonveterans. Behavioural health programmes and policies aimed at eliminating disparities between veterans and nonveterans are needed in Alabama.

Historical Trends in Veteran Community Substance Use Treatment: 2000-2019

Background: Substance use is a significant health crisis for the Veteran population. Prior research has thoroughly examined Veteran substance use within Veterans Health Administration (VHA) settings. However, such data tends to be outdated, and there is minimal research on substance use services delivered outside of VHA systems. This study examines historical patterns of Veteran substance use using a large sample of community-based substance-use treatment admissions. Methods: Data were drawn from the Substance Abuse and Mental Health Data Archive Treatment Episode Data Set-Admissions. Of the 39,425,886 total admissions between 2000 and 2019, 1,361,339 were of Veterans. Analyses compared Veteran versus non-Veteran admissions on demographics and historical trends in nature of substance-use admissions. Results: Relative to non-Veterans, Veteran admissions were more likely to be prompted by alcohol use. Over time, heterogeneity in substances prompting admissions has increased dramatically for both Veterans and non-Veterans, with particularly notable increases in opiate and stimulant use. Conclusion: Results suggest Veterans admitted to community substance-use treatment are unique relative to their non-Veteran peers. Development and implementation of treatments to target a range of substances while also considering the environmental challenges (e.g., homelessness) commonly faced by this population appear essential to best servicing community-based Veterans.