Barriers to Community Treatment for Opioid Use Disorders among Rural Veterans

Matthew R Filteau,Brandn Green,Kristal Jones

doi:10.21061/jvs.v7i3.262

Abstract

The Veterans Health Administration (VHA) has instituted several national initiatives to increase access to medication for opioid use disorder (MOUD). throughout rural America. The expansion of the MISSON Act’s community care model may prove beneficial, but barriers still constrain widespread community treatment for veterans. The present study illuminates several previously unidentified barriers facing community-based providers who aim to provide MOUD to rural veterans. The primary means of data collection for this study included in-depth interviews with fifty-three non-VHA MOUD providers, thirty-one staff at non-VHA community-based organizations serving veterans, and five VHA behavioral health employees affiliated with the Montana VHA’s substance use disorder program. Staff at non-VHA community-based organizations serving veterans refer veterans to the VHA for MOUD and express a low literacy level about non-VHA MOUD providers. VHA employees favor the VHA for MOUD and lack a network of collaboration with providers at non-VHA community care clinics. Attitudinal and structural barriers constrain veterans’ treatment options within community settings by creating a vacuum of care in the community, whereby all veterans are funneled to the VHA for MOUD. In Montana, only 6 veterans receive MOUD from non-VHA providers, and this reliance on the VHA’s MOUD program constrains access to treatment and the quality-of-care veterans receive.

Highlights

The Veterans Health Administration (VHA) is the largest integrated health and addiction treatment provider in the United States (Post et al, 2010; Trafton et al, 2013; VHA, 2008; Wyse et al, 2018)
Prior research has found that the VHA struggles to meet the demand for medication for opioid use disorder (MOUD), with some studies finding that only one third of veterans in need of MOUD receive it (Finlay et al, 2016; Oliva et al, 2013; Trafton et al, 2013; Wyse et al, 2018)
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

Summary

Introduction

The Veterans Health Administration (VHA) is the largest integrated health and addiction treatment provider in the United States (Post et al, 2010; Trafton et al, 2013; VHA, 2008; Wyse et al, 2018). The VHA funded a telemental health network whereby prescribers at “hub” VHA medical centers can treat veterans at distant “spokes,” such as rural, primary care focused community-based outpatient clinics (CBOCs; Brunet et al, 2020; US Government Accountability Office [US GAO], 2019) This effort has had some success, as approximately half of the veterans enrolled in VHA healthcare, who are receiving MOUD, rely on the CBOC network for access to treatment (Oliva et al, 2013). 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 collected qualitative data via interviews with employees at the Montana VHA, staff at community organizations serving veterans, and providers at STR/SOR sites to understand how the VHA’s model of care and the referral networks, through which veterans access MOUD serve as mutable barriers to the efficacy of the VA’s MISSION Act in rural and frontier areas

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