Improving Treatment Access for Veterans with Opioid Use Disorder
By: Kiana Stevens-Ward
About: Veterans are especially vulnerable to opioid use disorder due to their increased exposure to chronic pain and post-traumatic stress disorder (PTSD). States and local jurisdictions interested in supporting veteran populations should consider using opioid litigation dollars to fund partnerships between community care organizations and nearby VA health centers. By encouraging partnerships with local VA care services and community organizations, potential behavioral interventions such as creating additional virtual peer-led therapy support groups and harm reduction interventions can continue to promote medication and counseling treatment-seeking behaviors in the veteran population (Bennett et al., 2022).
Why Are Veterans at an Increased Risk of Using Opioids?
For the past two decades, the opioid epidemic in the U.S. has been a public health emergency due to the rising number of deaths by overdose (Bennett et al., 2022). Specifically, opioid overdose-related deaths increased by 41% in 2020 and 18% in 2021 (NSC, 2023). In addition, Americans who are at risk of opioid use disorder (OUD) are generally identified as minorities with lower socioeconomic backgrounds, mental conditions (i.e., post-traumatic stress disorder), and chronic pain (Bennett et al., 2022). As many of these factors relate to the U.S. military veteran population, they are especially at risk of OUD and OUD overdose-related deaths (Bennett et al., 2022). The mortality rate for drug-related overdose amongst U.S. veterans increased by 53.2% between 2010-2019; 93.4% of those deaths were due to opioids (Begley MR et al., 2022).
What States Should Consider:
Although the Veteran Affairs health system has continued to improve its interventions for opioid use disorder with its program, Veteran Community Partnership (VCP), there are less than 40 active VCPS across the country (Veteran Affairs, 2021). The patient demand for peer support and harm reduction treatment services is still high, and barriers to care remain (Misra-Hebert et al., 2015). Veterans struggle to access mental health counseling and medication for the treatment of opioid use disorder (i.e., buprenorphine and methadone), often due to concerns of extended wait times, limited access to affordable and convenient VA health care, fear of stigmatization, and lack of transportation to a VA health center (Misra-Hebert et al., 2015). For these reasons, veterans with opioid use disorder may benefit from the option of l virtual, peer-led support therapy groups that are tailored explicitly for veterans with OUD (Harris, 2022). Veterans often express feelings of isolation in civilian spaces and report better outcomes when they can engage with peers (Harris, 2022). For veterans with substance use disorder, services that allow them to identify with the shared experiences of their peers reduce these feelings of isolation and maybe encourage them to seek medication treatment and/or counseling services. Specifically, implementing more virtual formats for peer-led therapy groups allows veterans who do not have access to a local VA health center to access therapy care online. An example of a virtual peer-led support therapy group for veterans currently underway is the (Department of U.S. Veteran Affairs, 2020).
Principle 1 states that jurisdictions should use the dollars to support and expand existing opioid intervention efforts. For the veteran population, continued expansion of the VA’s current peer-support interventions would require partnerships between local communities and VA care services to promote treatment-seeking behaviors and increase access to services (Wyse et al., 2018). For instance, promoting the advertisement of the Veterans Community Partnership Program on social media and television platforms can reach local community leaders and encourage them to contact their nearby veteran regional office to form collaboration projects to implement more virtual peer-led teletherapy programs. This goal is feasible because peer-led therapy interventions are not unprecedented by the VA and have proven successful: “Opioid use among comprehensive Whole Health users decreased 38% compared with only an 11% decrease among those without Whole Health use (Department of U.S. Veteran Affairs, 2020).” However, these therapy programs are limited to 18 VA flagship onsite locations (Department of U.S. Veteran Affairs, 2020). The VA’s Well-Being Therapy Program could be expanded by building more partnerships with local community organizations. This goal may only be achieved through additional funding to maximize the efficiency of the VCP program and existing interventions through a collaborative effort with local communities and their nearby VA regional office (Wyse et al., 2018).
The VA department has expanded harm-reduction services by implementing Syringe Services Programs (SSP) within the Veterans Health Administration (VHA) (VA et al., 2023). Syringe Service Programs and other harm reduction interventions have a large body of evidence showing they can minimize the risk of transmitting HIV and hepatitis C and reduce opioid-related overdose deaths in veterans (Platt, 2018). This approach emphasizes the importance of “meeting people where they are” in their care timeline. Many veterans with opioid use disorder may already utilize harm reduction services in their community. To support the veteran populations, states may consider allocating funds towards promoting collaboration amongst veteran care services and existing community-based organizations to implement more veteran peer services that work within a harm reduction framework. This can help veterans who may not have access to VA health care and those who are not yet prepared to enter treatment.
By continuing to promote the partnership of veteran service programs and community organizations, we can create more opportunities for veterans to receive services such as peer-led counseling programs and increase access to harm reduction services for all veterans. Settlement funds may be an avenue to continue the expansion of these strategies to ultimately reduce OUD-related deaths, HIV and Hepatitis C transmission and improve treatment-seeking behaviors among our U.S. veterans.
About the Author:
Kiana Stevens-Ward is a Graduate Research Assistant for the Bloomberg Overdose Prevention Initiative and a second-year MSW/MPH candidate. Her research interests are focused on the implementation of state policies on substance use disorder treatment and understanding the impact of policies on U.S. veterans with complex PTSD, chronic pain, and substance use disorders to improve evidence-based communication strategies on harm reduction and medications for veterans with opioid use disorder.