Filteau et al.: Barriers to Community-Based Opiod Treatment among Rural Veterans
In Barriers to Community Treatment for Opioid Use Disorders among Rural Veterans (Journal of Veteran Studies), authors Matthew R. Filteau, Brandn Green, and Kristal Jones (all of JG Research and Evaluation, US) illuminate barriers that face community-based providers who aim to provide medical treatment for opioid use disorder (MOUD) to rural veterans throughout Montana.
To conduct the study, researchers primarily rely on in-depth interviews with non-Veterans Health Administration (VHA) MOUD providers, staff at non-VHA community-based organizations serving veterans, and VHA behavioral health employees affiliated with the Montana VHA’s substance use disorder program. This study was part of a broad evaluation of State Targeted Response (STR) and State Opioid Response (SOR) funding in Montana because of veterans being identified as a special population of concern.
A large barrier expressed in the interviews was how the VHA clearly expresses a preference of keeping the veterans enrolled in their own MOUD networks and will only refer veterans to non-VHA providers when the VHA does not offer a service or treatment, such as methadone. The article suggests this preference could stem from a multitude of things, such as an effort to capture certain reimbursement incentives and also a military culture that socializes its members to care for their own and prioritizes self-sufficiency.
As a consequence of this “in house” preference, there are reports of Montana veterans being denied MOUD services in times of need. The delay associated with this treatment quite literally means the person will be using opioids until their addiction needs can be met by the VHA. Therefore, the authors suggest these VHA preferences are negatively impacting veterans’ access to treatment. By creating these structural and attitudinal barriers against community-based care, many veterans are not receiving MOUD services when they need them. In sum, the preferences described may create a vacuum whereby all MOUD treatment funnels to the VHA, potentially exacerbating the VHA’s inability to provide quality care to all potential patients due to the demand for MOUD.
Ultimately, this article argues that increasing public knowledge of STR/SOR community-based programs and their ability to treat veterans is paramount to expand access to care for veterans suffering from OUD and other behavioral health disorders. The only conceivable way the MOUD needs of Montana veterans can be met, according to the authors, is if the divide between these providers is bridged – which will result in veterans receiving expedited, quality care.
