Community Treatment for Opioid Use Disorders in Urban and Rural Veterans

Abstract

Purpose The recent opioid crisis is characterized by a relatively greater increase in opioid use disorder and related mortality in rural populations when compared with urban populations.1‐5 As almost a quarter of our nation's veterans reside in rural settings, the United States Veterans Health Administration (VHA) is interested in the impact of this epidemic on rural veterans. This study aims to develop a comprehensive understanding of the trends in substance use disorders (SUD) in veterans seeking treatment from community, non‐VHA providers. Methods Using Substance Abuse and Mental Health Services Administration (SAMHSA)’s Treatment Episode Data Set (TEDS), this study presents the prevalence of treatment for veterans seeking initial admission into publicly funded non‐VHA SUD treatment centers for years 2011‐2016. Comparisons were made for all SUD types. Multivariate trend analysis based on annual data from 2011 to 2016 compared urban and rural veterans for opioid use disorder treatment. Findings Both urban and rural veterans had comparable rates of treatment for SUD, though rural veterans had slightly higher rates of injectable (11.2% vs 8.7%; P < .001) and opiate drug use disorder admissions (20.7% vs 18.1%; P = .014). Both urban and rural showed an increase in admissions for opioid, heroin, and injectable drug use disorders between 2011 and 2016 (P < .001). Conclusions Comprehensive understanding of veteran SUD and treatment should include national‐level data on community non‐VHA treatment. SAMHSA's TEDS for years 2011‐2016 provides clinical information for more than 90,000 veterans and indicates continued increase in treatment seeking for opioid use disorders, particularly for rural veterans.

Barriers to Community Treatment for Opioid Use Disorders among Rural Veterans

“…The present study highlights that staff at the Montana VHA prioritize a model of care internal to the VHA, rather than referring veterans to community care providers who specialize in MOUD. Despite calls to expand the community care model nationwide (Blanco et al, 2020;Turvey et al, 2020), VHA staff in this study report a preference for VHA behavioral health and MOUD, which may explain why the community care model has not been widely adopted by the Montana VHA (Gordon et al, 2020).…”

“…In community, non-VHA settings, MOUD admissions increased significantly from 2011 to 2016 for both urban and rural veterans, with the increases in admissions being greater for rural veterans (Turvey et al, 2020). Following Turvey et al's (2020) call to examine veterans in community, non-VHA settings, the present study develops logical hypotheses, rather than statistical inferences, for why community-based providers who aim to prescribe buprenorphine to veterans living in a rural state see little demand for their services. The national trends of increased utilization of MOUD among rural veterans identified by Turvey et al (2020) are not emblematic of what occurred in Montana-where less than 1% of patients prescribed buprenorphine at State Targeted Response (STR) and State Opioid Response (SOR)funded, non-VHA facilities were veterans (Green & Filteau, 2019).…”

“…Prior studies suggested that these initiatives have improved access to MOUD for veterans, as half of the veterans enrolled in VA healthcare who receive MOUD do so through the CBOC system (Oliva et al, 2013). In community, non-VHA settings, MOUD admissions increased significantly from 2011 to 2016 for both urban and rural veterans, with the increases in admissions being greater for rural veterans (Turvey et al, 2020). Following Turvey et al's (2020) call to examine veterans in community, non-VHA settings, the present study develops logical hypotheses, rather than statistical inferences, for why community-based providers who aim to prescribe buprenorphine to veterans living in a rural state see little demand for their services.…”

“…Following Turvey et al's (2020) call to examine veterans in community, non-VHA settings, the present study develops logical hypotheses, rather than statistical inferences, for why community-based providers who aim to prescribe buprenorphine to veterans living in a rural state see little demand for their services. The national trends of increased utilization of MOUD among rural veterans identified by Turvey et al (2020) are not emblematic of what occurred in Montana-where less than 1% of patients prescribed buprenorphine at State Targeted Response (STR) and State Opioid Response (SOR)funded, non-VHA facilities were veterans (Green & Filteau, 2019). We examine this unique case and explore how localized barriers impede veterans' access to MOUD at nine non-VHA facilities.…”

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

“…Evidence‐based programmes to support rural community‐based suicide prevention programmes for veterans are limited (Monteith et al., 2020). While treatment rates for substance use disorders (SUDs) among veterans in urban and rural areas are comparable (e.g., Turvey et al., 2020), further similarities and differences are worth noting. Veterans' treatment admissions for opioid use, heroin use and injectable drug use disorders increased between 2011 and 2016 (Turvey et al., 2020).…”