• Andrea K Finlay, Erica Morse, Matthew Stimmel, Emmeline Taylor, Christine Timko, HarrisAlex H SAHSCenter for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Road (MPD-152), Menlo Park, Willow, CA, 94025, USA.Department of Surgery, Stanford University School of Medicine, Stanford, USA., David Smelson, Mengfei Yu, Jessica Blue-Howells, and Ingrid A Binswanger.
• Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Road (MPD-152), Menlo Park, Willow, CA, 94025, USA. Andrea.Finlay@va.gov.
• J Gen Intern Med. 2020 Sep 1; 35 (9): 2529-2536.

BackgroundVeterans involved in the legal system are at high risk for overdose but have lower receipt of medications for opioid use disorder than other veterans.ObjectiveThe study aimed to understand barriers to medication access from the perspective of legally involved veterans with opioid use disorder and people who work with these veterans in the Veterans Health Administration (VHA) and the legal system.DesignThis national qualitative study interviewed veterans and stakeholders from 14 geographically diverse VHA facilities to explore perceptions of barriers to medications for opioid use disorder.ParticipantsParticipants included veterans with a history of opioid use disorder and legal involvement (n = 18), VHA Veterans Justice Programs Specialists (n = 15), VHA and community substance use disorder treatment providers (n = 5), and criminal justice staff (n = 12).ApproachWe conducted interviews based on the Consolidated Framework for Implementation Research. Interview transcripts were analyzed using a team-based approach.Key ResultsFour key barriers, noted by group, were identified: (1) a preference for counseling along with or instead of medications (veterans, Specialists, treatment providers, criminal justice staff); (2) concerns about veterans using medications without a prescription, selling them, or providing them to others (veterans, Specialists, treatment providers, criminal justice staff); (3) concerns about perceived stigma towards medication use (veterans, Specialists, treatment providers, criminal justice staff); and (4) concerns about medication discontinuation after recurrent opioid use (veterans, criminal justice staff). A fifth theme, education, was noted by all stakeholders except providers as important to facilitating use of medications for opioid use disorder. All five themes mapped to the framework construct of knowledge and beliefs about the intervention.ConclusionsBased on identified barriers, interventions focused on enhancing medication knowledge, reducing stigma towards use of medications, and increasing knowledge that opioid use may recur during treatment may help increase access to medication for veterans with legal involvement.

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