Pain and Opioid Use: Evidence for Integrating Acupuncture Into Treatment Planning

The epidemics of pain and opioid use pose unique challenges. Comprehensive approaches are required to address minds, bodies and spirits of individuals who live with pain and/or opioid use. The lack of an effective “quick fix” for either condition necessitates developing effective, innovative and multi-disciplinary avenues for treatment. This analytic article reviews epidemiological and demographic factors associated with pain and with opioid use and additional challenges posed by the Covid-19 epidemic. Several large-scale studies and meta-analyses have examined the role of acupuncture as a nonpharmacological approach to pain management as well as a component of comprehensive strategies to address opioid use disorder. We review and describe these in the context of safety, effectiveness, access and cost-related factors. With one in four U.S. hospitals as well as 88% of Veterans Health Administration facilities incorporating acupuncture, the feasibility of mobilizing and scaling up these treatment resources is being developed and demonstrated. We also identify potential facilitators and barriers to implementing acupuncture treatment. As part of a multi-disciplinary approach to pain management and/or opioid use disorder, we suggest that integrating acupuncture into treatment protocols may represent a viable strategy that is based on and consistent with public health principles.

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Fluctuations in barriers to medication treatment for opioid use disorder prescribing over the course of a one-year external facilitation intervention

Addiction Science & Clinical Practice ◽

10.1186/s13722-021-00259-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Allison M. Gustavson ◽

Marie E. Kenny ◽

Jennifer P. Wisdom ◽

Hope A. Salameh ◽

Princess E. Ackland ◽

...

Keyword(s):

Implementation Strategies ◽

Opioid Use Disorder ◽

Veterans Health ◽

Health Administration ◽

Opioid Use ◽

Medication Treatment ◽

Conceptual Clarity ◽

Parihs Framework ◽

External Facilitation ◽

Over Time

Abstract Background The Veterans Health Administration (VHA) is invested in expanding access to medication treatment for opioid use disorder (MOUD) to save lives. Access varies across VHA facilities and, thus, requires implementation strategies to promote system-wide adoption of MOUD. We conducted a 12-month study employing external facilitation that targeted MOUD treatment among low-adopting VHA facilities. In this study, we sought to evaluate the patterns of perceived barriers over 1 year of external implementation facilitation using the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Methods We randomly selected eight VHA facilities from the bottom quartile of the proportion of Veterans with an OUD diagnosis receiving MOUD (< 21%). The 1-year external implementation intervention included developmental evaluation to tailor the facilitation, an on-site visit, and monthly facilitation calls. Facilitators recorded detailed notes for each call on a structured template. Qualitative data was analyzed by coding and mapping barriers to the constructs in the i-PARIHS framework (Innovation, Recipients, Context). We identified emerging themes within each construct by month. Results Barriers related to the Innovation, such as provider perception of the need for MOUD in their setting, were minimal throughout the 12-month study. Barriers related to Recipients were predominant and fluctuated over time. Recipient barriers were common during the initial months when providers did not have the training and waivers necessary to prescribe MOUD. Once additional providers (Recipients) were trained and waivered to prescribe MOUD, Recipient barriers dropped and then resurfaced as the facilities worked to expand MOUD prescribing to other clinics. Context barriers, such as restrictions on which clinics could prescribe MOUD and fragmented communication across clinics regarding the management of patients receiving MOUD, emerged more prominently in the middle of the study. Conclusions VHA facilities participating in 12-month external facilitation interventions experienced fluctuations in barriers to MOUD prescribing with contextual barriers emerging after a facilitated reduction in recipient- level barriers. Adoption of MOUD prescribing in low-adopting VHA facilities requires continual reassessment, monitoring, and readjustment of implementation strategies over time to meet challenges. Although i-PARIHS was useful in categorizing most barriers, the lack of conceptual clarity was a concern for some constructs.

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Sex Differences in Opioid Use Disorder Prevalence and Multimorbidity Nationally in the Veterans Health Administration

Journal of Dual Diagnosis ◽

10.1080/15504263.2021.1904162 ◽

2021 ◽

pp. 1-11

Author(s):

MacKenzie R. Peltier ◽

Mehmet Sofuoglu ◽

Ismene L. Petrakis ◽

Elina Stefanovics ◽

Robert A. Rosenheck

Keyword(s):

Sex Differences ◽

Veterans Health Administration ◽

Opioid Use Disorder ◽

Veterans Health ◽

Health Administration ◽

Opioid Use

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Association of Medication-Assisted Treatment and Age With Treatment Completion Among Veterans Seeking Non-VA Treatment for Opioid use Disorder at Non-Veterans Health Administration Facilities

Military Medicine ◽

10.1093/milmed/usab242 ◽

2021 ◽

Author(s):

Joseph G Pickard ◽

Carissa van den Berk-Clark ◽

Monica M Matthieu

Keyword(s):

Positive Impact ◽

Treatment Completion ◽

Armed Forces ◽

Opioid Use Disorder ◽

Prescription Opioid ◽

Health Administration ◽

Opioid Use ◽

Data Set ◽

Medication Assisted Treatment

ABSTRACT Background Medication-assisted treatment has been shown to be effective in treating opioid use disorder among both older adults and veterans of U.S. Armed Forces. However, limited evidence exists on MAT’s differential effect on treatment completion across age groups. This study aims to ascertain the role of MAT and age in treatment completion among veterans seeking treatment in non–Department of Veterans Affairs healthcare facilities for opioid use disorder. Methods We used the Treatment Episode Data Set—Discharges (TEDS-D; 2006-2017) to examine trends in treatment and MAT usage over time and TEDS-2017 to determine the role of age and MAT in treatment completion. We examined a subset of those who self-identified as veterans and who sought treatment for an opioid use disorder. Results Veterans presented in treatment more often as heroin users than prescription opioid users, and older veterans were more likely to get MAT than younger veterans. We found that before propensity score matching, MAT initially appeared to be associated with a lower likelihood of treatment completion in inpatient ($\beta $ = −1.47, 95% CI −1.56 to −1.39) and outpatient ($\beta $ = −1.40, 95% CI −2.21 to −0.58) settings, and age (50+ years) appeared to mediate the effect of MAT on treatment completion ($\beta $ = −0.54, 95% CI −0.87 to −0.21). After matching, older veterans were more likely to complete substance use disorder treatment ($\beta $ = 0.21, 95% CI 0.01-0.42), while age no longer mediated the effect of MAT, and MAT had a significant positive impact on treatment completion in detox settings ($\beta $ = 1.36, 95% CI 1.15-1.50) and inpatient settings ($\beta $ = 1.54, 95% CI 1.37 -1.71). Conclusion The results show that age plays an important role in outpatient treatment completion, while MAT plays an important role in inpatient treatment completion. Implications for veterans are discussed.

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A national survey of barriers and facilitators to medications for opioid use disorder among legal-involved veterans in the Veterans Health Administration

Substance Abuse ◽

10.1080/08897077.2021.1975867 ◽

2021 ◽

pp. 1-8

Author(s):

Emmeline N. Taylor ◽

Christine Timko ◽

Ingrid A. Binswanger ◽

Alex H. S. Harris ◽

Matthew Stimmel ◽

...

Keyword(s):

National Survey ◽

Veterans Health Administration ◽

Opioid Use Disorder ◽

Barriers And Facilitators ◽

Veterans Health ◽

Health Administration ◽

Opioid Use

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Initiating opioid agonist treatment for opioid use disorder nationally in the Veterans Health Administration: Who gets what?

Substance Abuse ◽

10.1080/08897077.2019.1640831 ◽

2019 ◽

Vol 41 (1) ◽

pp. 110-120 ◽

Cited By ~ 5

Author(s):

Ajay Manhapra ◽

Elina Stefanovics ◽

Robert Rosenheck

Keyword(s):

Veterans Health Administration ◽

Opioid Use Disorder ◽

Veterans Health ◽

Health Administration ◽

Opioid Use ◽

Opioid Agonist ◽

Opioid Agonist Treatment

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Opioid use disorder and homelessness in the Veterans Health Administration: The challenge of multimorbidity

Journal of Opioid Management ◽

10.5055/jom.2018.0447 ◽

2018 ◽

Vol 14 (3) ◽

pp. 171-182 ◽

Cited By ~ 10

Author(s):

Theddeus Iheanacho, MD ◽

Elina Stefanovics, PhD ◽

Robert Rosenheck, MD

Keyword(s):

Risk Factor ◽

Service Use ◽

Veterans Health Administration ◽

Opioid Use Disorder ◽

Fiscal Year ◽

Veterans Health ◽

Health Administration ◽

Opioid Use ◽

Agonist Therapy ◽

Homeless Veterans

Objective: The aim of this study is to estimate the prevalence and sociodemographic and clinical correlates of opioid use disorder (OUD), a major cause of morbidity and mortality in the United States, among homeless veterans nationally in the Veterans Health Administration (VHA).Design: Administrative data on 256,404 veterans who were homeless and/or had OUD in fiscal year 2012 were analyzed to evaluate OUD as a risk factor for homelessness along with associated characteristics, comorbidities, and patterns of service use. Bivariate analyses and logistic regression were used to compare homeless veterans with OUD to veterans with OUD but no homelessness and homeless veterans with no OUD.Results: Altogether 17.9 percent of homeless VHA users were diagnosed with OUD and 34.6 percent of veterans with OUD were homeless. The risk ratio (RR) for homelessness among veterans with OUD was 28.7. Homeless veterans with OUD, compared to nonhomeless veterans with OUD showed extensive multimorbidity with greater risk for HIV (RR = 1.57), schizophrenia (RR = 1.62), alcohol use disorder (RR = 1.67), and others. Homeless veterans with OUD also showed more multimorbidity and used more services than homeless veterans without OUD. Homeless and nonhomeless OUD veterans used opiate agonist therapy at similar, but very low rates (13 and 15 percent).Conclusions: OUD is a major risk factor for homelessness. Homeless veterans with OUD have high levels of multimorbidity and greater service use than veterans with either condition alone. Tailored, facilitated access to opioid agonist therapy may improve outcomes for these vulnerable veterans.

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Screening for homelessness among individuals initiating medication-assisted treatment for opioid use disorder in the Veterans Health Administration

Journal of Opioid Management ◽

10.5055/jom.2015.0298 ◽

2015 ◽

Vol 11 (6) ◽

pp. 459 ◽

Cited By ~ 5

Author(s):

Marcus A. Bachhuber, MD, MSHP ◽

Christopher B. Roberts, MPH ◽

Stephen Metraux, PhD ◽

Ann Elizabeth Montgomery, PhD

Keyword(s):

At Risk ◽

Addiction Treatment ◽

Women Veterans ◽

Opioid Use Disorder ◽

Treatment Programs ◽

Veterans Health ◽

Health Administration ◽

Opioid Use ◽

Medication Assisted Treatment ◽

Male Veterans

Objective: To determine the prevalence of homelessness and risk for homelessness among veterans with opioid use disorder initiating treatment. Setting: Addiction treatment programs operated by the US Department of Veterans Affairs (VA).Participants: All veterans initiating treatment with methadone or buprenorphine for opioid use disorder between October 1, 2013 and September 30, 2014 (n = 2,699) who were administered the VA’s national homelessness screener. Main outcome measures: Self-reported homelessness or imminent risk of homelessness.Results: The prevalence of homelessness was 10.2 percent and 5.3 percent were at risk for homelessness. Compared to male veterans, women veterans were less likely to report homelessness (8.9 percent vs 10.3 percent) but more likely to be at risk (11.8 percent vs 4.9 percent). By age group, veterans aged 18-34 and 45-54 years most frequently reported homelessness (12.0 and 11.7 percent, respectively) and veterans aged 45-54 and 55-64 years most frequently reported risk for homelessness (6.5 and 6.8 percent, respectively).Conclusions: The prevalence of homelessness in this population is approximately 10 times that of the general veteran population accessing care at VA. Screening identified a substantial number of veterans who could benefit from VA housing assistance and had not received it recently. Programs to address veteran homelessness should engage with veterans seeking addiction treatment. Integration of homelessness services into addiction treatment settings may, in turn, improve outcomes.

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