The American journal on addictions
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This study examines the relationship between institutional fiscal strain and the availability of opiate substitution therapy (eg, methadone maintenance), an effective but relatively expensive treatment for heroin addiction. An observational design was used to examine the association of changes in funding and changes in provision for treating opiate addiction at 29 VA Medical Centers (VAMCs). We hypothesized that VAMCs experiencing greater fiscal strain would show reduced availability of opiate substitution treatment. ⋯ There were no significant relationships between changes in the delivery of opiate substitution services and changes in per capita funding at any of the four institutional levels. No new programs were started during these years. Although no new programs were started, the availability of opiate substitution therapy at VA facilities with existing programs was maintained over a five-year period regardless of local funding changes, although at somewhat reduced intensity.
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The use of opioid medications for analgesia is associated with concerns about adverse side effects and the potential for development of physical dependence, tolerance, or addiction. Pain often is undertreated, which may provoke drug-seeking behavior by patients. ⋯ Important tools for addiction screening include the use of questionnaires, patient interviews, and lab tests. In this study, the physiological and behavioral consequences of chronic pain and its treatment with opioids, along with guidelines for prescribing opioid pain medication, are presented.