Dual Degree Virtual Presentation: MPH (Health Policy and Management) 

Author: Jennifer Diaz

Motivation: In 2014, the Veterans Health Administration (VHA) became the first national healthcare system to implement opioid Overdose Education and Naloxone Distribution (OEND) programs throughout its clinical sites. Emergency departments hold an immense platform to service individuals with opioid use disorder (OUD) and are a vital setting for buprenorphine initiation among untreated OUD patients; Despite the 2009 and 2015 recommended clinical practice guideline from the US Department of Veterans affairs advocating for the use of medications like buprenorphine as primary treatment for OUD, it continues to be underutilized within the VA system4.

Objective: The goal of this project will be to evaluate buprenorphine prescription trends in VISN 22 (which includes eight VA emergency departments in the southwest United States), using fiscal year data pre- and post-implementation of the Addiction Hotline from 2017 to present. To evaluate the impact of the VEMAH service on VISN 22 EDs, we will utilize a segmented regression of interrupted time series analysis. We will also compare trends in VISN 22 to other geographically similar VISNs without access to VEMAH services. Since VEMAH services also included support of ED naloxone distribution for veterans at risk for opioid-related overdose death, we plan to perform a similar analysis of ED naloxone prescribing rates pre- and post-VEMAH. These data will guide our understanding of the efficacy of the program to improve ED provider buprenorphine and naloxone prescribing patterns. 

Lessons Learned: Prior research identifying barriers to M-OUD initiation and naloxone distribution for health care professionals in VA ED and urgent care centers identified the following to be pertinent barriers: initiation falling outside of ED's scope of providing acute OUD treatment, staffing concerns, and educational gaps5. 

Summary: A problem of concern is that while the FDA has approved buprenorphine as a medication for OUD, patients within the VA system remain under-treated due to varying levels of physician readiness in prescribing buprenorphine 4,5. 

References

1.Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2022. Available at http://wonder.cdc.gov.

2. Bohnert ASB, Ilgen MA, Galea S, McCarthy JF, Blow FC. Accidental poisoning mortality among patients in the Department of Veterans Affairs health system. Med Care. 2011;49(4):393-396. doi:10.1097/MLR.0b013e318202aa27 

3. Ma J, Bao Y-P, Wang R-J, et al. Effects of medication- assisted treatment on mortality among opioids users: a systematic review and meta-analysis. Mol Psychiatry. 2019;24(12):1968-1983. doi:10.1038/s41380-018-0094-5

4. Wyse JJ, Gordon AJ, Dobscha SK, et al. Medications for opioid use disorder in the Department of Veterans Affairs (VA) health care system: historical perspective, lessons learned, and next steps. Subst Abuse. 2018;39(2):139- 144. doi:10.1080/08897077.2018.1452327

5.Sasson C,  Dieujuste N,  Klocko R, et al.  Barriers and facilitators to implementing medications for opioid use disorder and naloxone distribution in Veterans Affairs emergency departments. Acad Emerg Med.  2023; 30: 289-298. doi:10.1111/acem.14683