Reducing barriers to medications for opioid use disorder

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Emily Williams (PhD, MPH), Madeline Frost (PhD, MPH), and fellow researchers published the paper, “The Only Reason I Am Willing to Do It at All”: Evaluation of VA’s Supporting Primary care Providers in Opioid Risk reduction and Treatment (SUPPORT) Center in the Journal of Addiction Medicine.

There have been several barriers to identifying and prescribing medications for opioid use disorder (MOUD) and veterans represent a vulnerable population, “because pain, multimorbidity, and dual use of VA and non-VA health care are common and associated with increased risk.” The researchers continued, “From 2010 to 2019, 18,573 VA patients died of overdose, and opioid-involved overdose mortality increased 93%.” Despite several large-scale efforts from the VA to increase MOUD, less than half of VA patients with OUD have received medication as treatment.

Through the SUPPORT Center, researchers partnered with clinical leaders to increase opioid-related safety by assisting VA primary caregivers to identify and treat opioid use disorder (OUD).

From 2019-2021, SUPPORT provided care to 167 patients, initiated MOUD with buprenorphine to 38 patients, provided 72 patients with overdose education and naloxone, and facilitated 218 providers with training. Findings from SUPPORT offer a potential model for outpatient MOUD treatment. The researchers observed, “SUPPORT’s stepped care model delivered by dedicated clinical staff offered needed OUD treatment in caring and patient-centered ways and helped to train providers and increase their comfort offering MOUD.”

“Working on SUPPORT was extremely lifegiving due to an amazing show of teamwork that enhanced patient-centered care for opioid use disorders and really seemed to improve the lives of the people who received care. The clinical team—Carly Hood and Carol Achtmeyer—was an incredible resource both for patients and primary care providers and helped to break down stigma and fear on both sides. I am very grateful to have been able to share this with my Co-PI Eric Hawkins, collaborator Maddie Frost, the rest of the research and clinical team, and with VA primary care clinics and Veteran patients, and this experience only enhances my view that the research partnerships, whether with clinics or communities, are an optimal approach to changing care, health, and ultimately lives.”

-Dr. Emily Williams

Dr. Williams, professor in the Department of Health Systems and Population Health and director of the Health Services PhD program, earned her doctoral degree from the program in 2009. She’s also a core investigator and co-director of post-doctoral fellowship within the Seattle-Denver Center of Innovation (COIN) for Veteran-Centered Value-Driven Care at VA Puget Sound Health Services Research & Development (HSR&D).

Dr. Frost is a VA HSR Advanced PhD Fellow for Seattle-Denver COIN. She earned both her PhD (2022) and MPH (2017) degrees from the Department of Health Systems and Population Health.

Fellow researchers included Anissa N. Danner, MSW; Aline M. K. Lott, MA; Carol E. Achtmeyer, MN, ARNP; Carly L. Hood, MSW; Carol A. Malte, MSW; Andrew J. Saxon, MD; and Eric J. Hawkins, PhD.

For a more in-depth breakdown of the SUPPORT Center’s methods and results:

Read the full paper

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