Improving Veteran Access to Opioid Use Disorder Treatment Opioid use disorder (OUD) continues to be a nationwide problem, and clinicians within the VA health care system are working to address the impacts of this crisis. Studies have shown that an increase in the prescribing of opioids is associated with parallel increases in nonmedical opioid use, overdose deaths, and OUD. Per the VA Strategic Plan, suicide prevention—which involves improving access to mental health services including OUD treatment and preventing overdose—is the top VA clinical priority.
In response, the VA Office of Mental Health and Suicide Prevention, in partnership with the Employee Education System and QUERI, launched the Stepped Care for Opioid Use Disorder Train-the-Trainer (SCOUTT) program, a national initiative to improve access to medications (e.g., buprenorphine) for OUD in primary care, pain management, and mental health clinics.
The VA Puget Sound Center of Excellence for Substance Addiction Treatment and Education (CESATE), directed by Andrew Saxon, MD, is conducting an ongoing evaluation of SCOUTT to understand providers’ perspectives on the initiative and the outcomes for Veteran participants. This effort is being led by CESATE Associate Director, Eric Hawkins, PhD. Following the SCOUTT rollout, evaluators began monitoring the progress using key metrics, including the number of Veterans receiving and providers prescribing medications for OUD in the implementation clinics and the percentage of Veterans receiving medications for 90 days or more. Results indicate:
- A 107% increase in the number of patients with OUD who were prescribed buprenorphine in implementation clinics from August 2018 to June 2019.
- A 68% increase in the number of buprenorphine prescribers in implementation clinics from August 2018 to June 2019.
- On average, 70% of patients retained in buprenorphine treatment for 90 days or longer.
Evaluation of SCOUTT will continue for the next two years. Evaluation efforts will focus on continued monitoring of the progress metrics described above and surveying and interviewing key individuals at the implementation facilities. Plans for a second rollout of the SCOUTT initiative are underway.