Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 Jun;38(8):1871-1876.
doi: 10.1007/s11606-023-08027-4. Epub 2023 Jan 23.

Access to Medications for Opioid Use Disorder in Rural Versus Urban Veterans Health Administration Facilities

Jessica J Wyse  1   2 , Sarah Shull  3 , Stephan Lindner  4   5   6 , Benjamin J Morasco  3   7 , Adam J Gordon  8   9 , Kathleen F Carlson  3   4 , P Todd Korthuis  4   10   11 , Sarah S Ono  3   7   12 , Joseph G Liberto  13   14 , Travis I Lovejoy  3   7   12
Affiliations
Observational Study

Access to Medications for Opioid Use Disorder in Rural Versus Urban Veterans Health Administration Facilities

Jessica J Wyse et al. J Gen Intern Med. 2023 Jun.

Abstract

Background: For patients with opioid use disorder (OUD), medications for OUD (MOUD) reduce morbidity, mortality, and return to use. Nevertheless, a minority of patients receive MOUD, and underutilization is pronounced among rural patients.

Objective: While Veterans Health Administration (VHA) initiatives have improved MOUD access overall, it is unknown whether access has improved in rural VA health systems specifically. How "Community Care," healthcare paid for by VHA but received from non-VA providers, has affected rural access is also unknown.

Design: Data for this observational study were drawn from the VHA Corporate Data Warehouse. Facility rurality was defined by rural-urban commuting area code of the primary medical center. International Classification of Diseases codes identified patients with OUD within each year, 2015-2020. We included MOUD (buprenorphine, methadone, extended-release naltrexone) received from VHA or paid for by VHA but received at non-VA facilities through Community Care. We calculated average yearly MOUD receipt; linear regression of outcomes on study years identified trends; an interaction between year and rural status evaluated trend differences over time.

Participants: All 129 VHA Health Systems, a designation that encompasses one or more medical centers and their affiliated community-based outpatient clinics MAIN MEASURES: The average proportion of patients diagnosed with OUD that receive MOUD within rural versus urban VHA health care systems.

Key results: From 2015 to 2020, MOUD access increased substantially: the average proportion of patients receiving MOUD increased from 34.6 to 48.9%, with a similar proportion of patients treated with MOUD in rural and urban systems in all years. Overall, a small proportion (1.8%) of MOUD was provided via Community Care, and Community Care did not disproportionately benefit rural health systems.

Conclusions: Strategies utilized by VHA could inform other health care systems seeking to ensure that, regardless of geographic location, all patients are able to access MOUD.

Keywords: access; opioid agonist; opioid use disorder; rural; veterans.

PubMed Disclaimer

Conflict of interest statement

Authors have no conflicts of interest to report.

Disclaimer

The content is solely the responsibility of the authors and does not represent the official views of the Department of Veterans Affairs.

Figures

Figure 1
Figure 1
Change in the use of a all MOUD, b buprenorphine, c methadone, and d extend-release injectable naltrexone from 2015 to 2020, rural versus urban VHA Health Care Systems
See this image and copyright information in PMC

References

    1. Sordo L, Barrio G, Bravo MJ, Indave BI, Degenhardt L, Wiessing L, et al. Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. bmj. 2017;357. - PMC - PubMed
    1. National Academies of Sciences E and Medicine. Medications for opioid use disorder save lives. National Academies Press; 2019. - PubMed
    1. Wakeman SE, Larochelle MR, Ameli O, Chaisson CE, McPheeters JT, Crown WH, et al. Comparative Effectiveness of Different Treatment Pathways for Opioid Use Disorder. JAMA Netw Open. 2020;3(2):e1920622–e1920622. doi: 10.1001/jamanetworkopen.2019.20622. - DOI - PMC - PubMed
    1. Larochelle MR, Bernson D, Land T, Stopka TJ, Wang N, Xuan Z, et al. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study. Ann Intern Med. 2018;169(3):137–45. doi: 10.7326/M17-3107. - DOI - PMC - PubMed
    1. Showers B, Dicken D, Smith JS, Hemlepp A. Medication for opioid use disorder in rural America: A review of the literature. J Rural Ment Health. 2021;45(3):184. doi: 10.1037/rmh0000187. - DOI

Publication types

MeSH terms