Substance abuse : official publication of the Association for Medical Education and Research in Substance Abuse
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Opioid use disorder (OUD) is a critical concern among US veterans. The Veterans Health Administration (VHA) recommends buprenorphine as a first-line treatment for OUD; however, only 35% of veterans with an OUD currently receive medication treatment. Practical barriers, including the capacity of providers to prescribe, may affect delivery of buprenorphine. We examined the current state of buprenorphine treatment within the VHA. ⋯ VHA providers are prescribing buprenorphine below their capacity. A multipronged approach to increase the number of credentialed providers and address barriers to prescribing is needed to ensure that veterans get effective treatment for OUD.
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The Veterans Health Administration (VHA) established a patient-centered medical home model of care for veterans experiencing homelessness called a Homeless Patient Aligned Care Team (HPACT) to improve engagement with primary care and reduce utilization of hospital-based services. To evaluate the impact of the HPACT model, this study compares the number and type of health care visits in the 12 months before and after enrollment in HPACT at one VHA facility, and explores patient characteristics associated with increases and decreases in visits. ⋯ An integrated HPACT model was successful in engaging homeless veterans in primary care for 1 year, potentially contributing to reductions in ED use. More tailored approaches may be needed for vulnerable populations experiencing homelessness, including homeless women.
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In response to the opioid epidemic and new guidelines, many patients on high-dose long term opioid therapy (LTOT) for chronic pain are getting tapered off opioids. As a result, a unique clinical challenge is emerging: while many on LTOT have poor pain control, functional decline, psychiatric instability, aberrancies and misuse, these issues may often worsen with opioid tapering. Currently, a clear explanation and practical guidance on how to manage this perplexing clinical scenario is lacking. ⋯ Awareness of the science of the neuroplasticity effects of repeated use of opioids is necessary to better manage these patients with complex challenges.
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Since 2014, the Department of Veterans Affairs (VA) has been working to address the ongoing opioid epidemic through opioid-education initiatives, the development of risk calculators, and other risk stratification tools. One primary focus of VA efforts has been the distribution of rescue naloxone kits to veterans at greatest risk of opioid-related adverse events. The purpose of this project was to identify primary care veterans at highest risk for serious opioid-related adverse events using the Risk Index for Overdose and Serious Opioid-Induced Respiratory Depression (RIOSORD) and offer rescue naloxone kits by telephone-based outreach. RIOSORD is a risk-stratification tool developed and validated within the veteran population. ⋯ This project demonstrated that telephone-based outreach can be one method of distributing rescue naloxone to a high-risk patient population without requiring an in-person visit to a provider.
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Effective intervention for risky drinking requires that clinicians and patients know low-risk daily and weekly guidelines and what constitutes a "standard drink." The authors hypothesized that most patients lack this knowledge, and that education is required. ⋯ Most patients in primary care don't know specifics of the National Institute on Alcohol Abuse and Alcoholism (NIAAA) guidelines for low-risk drinking. Exploring patient perceptions of low-risk guidelines and current drinking behavior may reveal discrepancies worth discussing. For risky drinkers, most of whom don't know daily and weekly low-risk guidelines or standard drink sizes, education can be vital in intervening. Findings suggest the need for detailed and explicit social marketing and communication on exactly what low-risk drinking entails.