The US is confronted with a rise in opioid use disorder (OUD), opioid misuse, and opioid-associated harms. Medication treatment for opioid use disorder (MOUD)—including methadone, buprenorphine and naltrexone—is the gold standard treatment for OUD. MOUD reduces illicit opioid use, mortality, criminal activity, healthcare costs, and high-risk behaviors. The Veterans Health Administration (VHA) has invested in several national initiatives to encourage access to MOUD treatment. Despite these efforts, by 2017, just over a third of all Veterans diagnosed with OUD received MOUD. VHA OUD specialty care is often concentrated in major hospitals throughout the nation and access to this care can be difficult due to geography or patient choice. Recognizing the urgent need to improve access to MOUD care, in the Spring of 2018, the VHA initiated the Stepped Care for Opioid Use Disorder, Train the Trainer (SCOUTT) Initiative to facilitate access to MOUD in VHA non-SUD care settings. The SCOUTT Initiative's primary goal is to increase MOUD prescribing in VHA primary care, mental health, and pain clinics by training providers working in those settings on how to provide MOUD and to facilitate implementation by providing an ongoing learning collaborative. Thirteen healthcare providers from each of the 18 VHA regional networks across the VHA were invited to implement the SCOUTT Initiative within one facility in each network. We describe the goals and initial activities of the SCOUTT Initiative leading up to a two-day national SCOUTT Initiative conference attended by 246 participants from all 18 regional networks in the VHA. We also discuss subsequent implementation facilitation and evaluation plans for the SCOUTT Initiative. The VHA SCOUTT Initiative could be a model strategy to implement MOUD within large, diverse health care systems.

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Background In the United States, an x‐waiver credential is necessary to prescribe buprenorphine medication treatment for opioid use disorder (B‐MOUD). Historically, this process has required certified training, which could be a barrier to obtaining an x‐waiver and subsequently prescribing. To address this barrier, the US recently removed the training requirement for some clinicians. We sought to determine if clinicians who attended x‐waiver training went on to obtain an x‐waiver and prescribe B‐MOUD, and to examine what facilitated or impeded B‐MOUD prescribing. Methods In September 2020, we conducted a cross‐sectional, electronic survey of attendees of 15 in‐person x‐waiver pieces of training from June 2018 to January 2020 within the Veterans Health Administration (VHA). Of the attendees (n = 321), we surveyed current VHA clinicians who recalled taking the training. The survey assessed whether clinicians obtained the x‐waiver, had prescribed B‐MOUD, and barriers or facilitators that influenced B‐MOUD prescribing. Results Of 251 eligible participants, 62 (24.7%) responded to the survey, including 27 (43.5%) physicians, 16 (25.8%) advanced practice clinicians, and 12 (19.4%) pharmacists. Of the 43 clinicians who could prescribe, 29 (67.4%) had obtained their x‐waiver and 16 (37.2%) had reported prescribing B‐MOUD. Prominent barriers to prescribing B‐MOUD included a lack of supporting clinical staff and competing demands on time. The primary facilitator to prescribing was leadership support. Conclusion and Scientific Significance Nine months after x‐waiver training, two‐thirds of clinicians with prescribing credentials had obtained their x‐waiver and one‐third were prescribing B‐MOUD. Removing the x‐waiver training may not have the intended policy effect as other barriers to B‐MOUD prescribing persist.