Underutilization of the Current Clinical Capacity to Provide Buprenorphine Treatment for Opioid use Disorders within the Veterans Health Administration

Abstract

Background: Opioid use disorder (OUD) is a critical concern among US veterans. The Veterans Health Administration (VHA) recommends buprenorphine as a first-line treatment for OUD; however, only 35% of veterans with an OUD currently receive medication treatment. Practical barriers, including the capacity of providers to prescribe, may affect delivery of buprenorphine. We examined the current state of buprenorphine treatment within the VHA. Methods: National VHA administrative databases were queried to identify all providers credentialed to prescribe buprenorphine as of January 2018. Data were extracted on providers’ prescribing capacity (30, 100, or 275 patients concurrently) and number of patients who received buprenorphine in the prior 180 days. Results: A total of 1458 VHA providers were credentialed to prescribe buprenorphine. Forty-three percent of providers had not prescribed buprenorphine to any VHA patients in the past 180 days. Of those that prescribed to at least 1 patient, providers still prescribed to fewer patients than their capacity, regardless of their patient panel size (30, 100, or 275), prescribing to 18.5 patients on average. Conclusions: VHA providers are prescribing buprenorphine below their capacity. A multipronged approach to increase the number of credentialed providers and address barriers to prescribing is needed to ensure that veterans get effective treatment for OUD.

Polysubstance use and association with opioid use disorder treatment in the US Veterans Health Administration

“…In addition, patients with polysubstance use may be more likely seen in SUD settings, and those seen in SUD settings are more likely to be diagnosed with additional SUDs. However, this should not alter the finding that polysubstance use was associated with a lower likelihood of receiving buprenorphine treatment, especially because the vast majority of buprenorphine prescribing in the VHA occurs in SUD specialty settings [53]. The study focuses on Veterans, an important population at higher risk for overdose than the general population [54] and with similar prevalence of OUD compared to the non‐Veteran population in the United States [55].…”

Availability of Medications for the Treatment of Alcohol and Opioid Use Disorder in the USA

“…Although the total number of buprenorphine-waivered providers in the VHA increased from 17 waivered providers in 2003 to 1458 waivered providers in 2018, approximately 43% of waivered providers did not prescribe any buprenorphine in the past 180 days. The same study found that waivered VHA providers prescribed well below their patient limits [112].…”

“…A separate body of research has examined the availability of substance use disorder medications in the VHA [108][109][110][111][112]. Of note, because the VHA is an integrated health care system, it includes specialty substance use disorder treatment programs, primary care settings, and a variety of other inpatient and outpatient care settings.…”

Racial/Ethnic Differences in the Medical Treatment of Opioid Use Disorders Within the VA Healthcare System Following Non-Fatal Opioid Overdose

“…4 This undertreatment includes low rates of prescribing of medications for opioid use disorder (MOUDs), such as methadone, buprenorphine, and naltrexone. 5,6 This is due, in part, to the limited number of medical providers credentialed to prescribe buprenorphine, both within and outside VA. 7,8 More concerning among patients with non-fatal opioid overdoses, few individuals receive MOUD, and opioid prescribing patterns frequently remain unchanged following such overdoses based on studies performed outside VA. 9,10 These serious sentinel overdose events among opioid users represent opportune windows to taper or discontinue chronic, high-dose opioid use or to initiate MOUDs as effective forms of harm reduction.…”