title: Trends in opioid agonist therapy in the Veterans Health Administration: is supply keeping up with demand?
abstract: BACKGROUND
  Opioid agonist therapy (OAT) through addiction specialty clinic settings (clinic-based OAT) using methadone or buprenorphine or office-based settings using buprenorphine (office-based OAT) is an evidence-based treatment for opioid dependence. The low number of clinic-based OATs available to veterans (N = 53) presents a barrier to OAT access; thus, the expansion in office-based OAT has been encouraged.
  
  
  OBJECTIVE
  To examine trends in office-based OAT utilization over time and whether availability of office-based OAT improved the proportion of veterans with opioid use disorders treated with OAT.
  
  
  METHODS
  We examined Veterans Health Administration (VHA) administrative data for evidence of buprenorphine prescribing and clinic-based OAT clinic stops from October 2003 through September 2010 [fiscal years (FY) 2004-2010].
  
  
  RESULTS
  The number of patients receiving buprenorphine increased from 300 at 27 facilities in FY2004 to 6147 at 118 facilities in FY2010. During this time, the number of patients diagnosed with an opioid use disorder increased by 45%; however, the proportion of opioid use disorder patients receiving OAT remained relatively stable, ranging from 25% to 27%.
  
  
  CONCLUSIONS
  Office-based OAT utilization and the number of opioid use disorder veterans treated with OAT are increasing at the same rate over time, suggesting that office-based OAT is being used to meet the growing need for OAT care. Although office-based OAT is increasingly being used within the VHA and may be one way the VHA is keeping up with the demand for OAT, more research is needed to understand how to engage a greater proportion of opioid use disorder patients in treatment.
authors: Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, CA 94025, USA. elizabeth.oliva@va.gov
authors: Elizabeth M
authors: EM
authors: Oliva
authors: Jodie A
authors: JA
authors: Trafton
authors: Alex H S
authors: AH
authors: Harris
authors: Adam J
authors: AJ
authors: Gordon
mesh_terms: D006301:Health Services Needs and Demand / Q000639:trends*; D058850:Opiate Substitution Treatment / Q000706:statistics & numerical data / Q000639:trends*; D010342:Patient Acceptance of Health Care; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data / Q000639:trends*; D058014:Veterans Health / Q000639:trends