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J Stud Alcohol Drugs. 2018 Nov;79(6):909-917.

Barriers and Facilitators to Implementation of Pharmacotherapy for Opioid Use Disorders in VHA Residential Treatment Programs.

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Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California.
National Center on Homelessness Among Veterans, Department of Veterans Affairs, Menlo Park, California.
Center on Health Policy/Center for Primary Care and Outcomes Research, Stanford University, Stanford, California.
Kidney Health Research Collaborative, University of California San Francisco and VA San Francisco Health Care System, San Francisco, California.
Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California.
Department of Veterans Affairs, Veterans Health Administration, Salem, Virginia.
Department of Surgery, Stanford University School of Medicine, Stanford, California.



Despite evidence of effectiveness, pharmacotherapy-methadone, buprenorphine, or naltrexone-is prescribed to less than 35% of Veterans Health Administration (VHA) patients diagnosed with opioid use disorder (OUD). Among veterans whose OUD treatment is provided in VHA residential programs, factors influencing pharmacotherapy implementation are unknown. We examined barriers to and facilitators of pharmacotherapy for OUD among patients diagnosed with OUD in VHA residential programs to inform the development of implementation strategies to improve medication receipt.


VHA electronic health records and program survey data were used to describe pharmacotherapy provided to a national cohort of VHA patients with OUD in residential treatment programs (N = 4,323, 6% female). Staff members (N = 63, 57% women) from 44 residential programs (response rate = 32%) participated in interviews. Barriers to and facilitators of pharmacotherapy for OUD were identified from transcripts using thematic analysis.


Across all 97 residential treatment programs, the average rate of pharmacotherapy for OUD was 21% (range: 0%-67%). Reported barriers included provider or program philosophy against pharmacotherapy, a lack of care coordination with nonresidential treatment settings, and provider perceptions of low patient interest or need. Facilitators included having a prescriber on staff, education and training for patients and staff, and support from leadership.


Contrary to our hypothesis, barriers to and facilitators of pharmacotherapy for OUD in VHA residential treatment programs were consistent with prior research in outpatient settings. Intensive educational programs, such as academic detailing, and policy changes such as mandating buprenorphine waiver training for VHA providers, may help improve receipt of pharmacotherapy for OUD.

[Available on 2019-11-01]

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