title: Receipt of pharmacotherapy for opioid use disorder by justice-involved U.S. Veterans Health Administration patients.
abstract: BACKGROUND
  Pharmacotherapy - methadone, buprenorphine, or naltrexone - is an evidence-based treatment for opioid use disorder, but little is known about receipt of these medications among veterans involved in the justice system. The current study examines receipt of pharmacotherapy for opioid use disorder among veterans with a history of justice involvement at U.S. Veterans Health Administration (VHA) facilities compared to veterans with no justice involvement.
  
  
  METHODS
  Using national VHA clinical and pharmacy records, we conducted a retrospective cohort study of veterans with an opioid use disorder diagnosis in fiscal year 2012. Using a mixed-effects logistic regression model, we examined receipt of pharmacotherapy in the 1-year period following diagnosis as a function of justice involvement, adjusting for patient and facility characteristics.
  
  
  RESULTS
  The 1-year rate of receipt for pharmacotherapy for opioid use disorder was 27% for prison-involved veterans, 34% for jail/court-involved veterans, and 33% for veterans not justice-involved. Compared to veterans not justice-involved, those prison-involved had 0.75 lower adjusted odds (95% confidence interval [CI]: 0.65-0.87) of receiving pharmacotherapy whereas jail/court-involved veterans did not have significantly different adjusted odds.
  
  
  CONCLUSIONS
  Targeted efforts to improve receipt of pharmacotherapy for opioid use disorder among veterans exiting prison is needed as they have lower odds of receiving these medications.
authors.affiliation: Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA. Electronic address: Andrea.Finlay@va.gov.
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Finlay
authors.affiliation: Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA. Electronic address: Alexander.Harris2@va.gov.
authors.forename: Alex H S
authors.initials: AH
authors.lastname: Harris
authors.affiliation: Veterans Justice Programs, Department of Veterans Affairs, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA. Electronic address: Joel.Rosenthal@va.gov.
authors.forename: Joel
authors.initials: J
authors.lastname: Rosenthal
authors.affiliation: Veterans Justice Programs, Department of Veterans Affairs, Greater Los Angeles Health Care System, 11301 Wilshire Blvd., Los Angeles, CA 90073, USA. Electronic address: Jessica.Blue-Howells@va.gov.
authors.forename: Jessica
authors.initials: J
authors.lastname: Blue-Howells
authors.affiliation: Veterans Justice Programs, Department of Veterans Affairs, 2250 Leestown Road, Lexington, KY 40511, USA. Electronic address: Sean.Clark2@va.gov.
authors.forename: Sean
authors.initials: S
authors.lastname: Clark
authors.affiliation: Veterans Justice Programs, Department of Veterans Affairs, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA. Electronic address: jimfmcguire@yahoo.com.
authors.forename: Jim
authors.initials: J
authors.lastname: McGuire
authors.affiliation: Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA. Electronic address: ctimko@stanford.edu.
authors.forename: Christine
authors.initials: C
authors.lastname: Timko
authors.affiliation: Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA; Women's Health Service, Medical Service, VA Palo Alto Health Care System, 3801 Miranda Ave., Palo Alto, CA 94304, USA; Division of General Medical Disciplines, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA 94305, USA. Electronic address: Susan.Frayne@va.gov.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Frayne
authors.affiliation: National Center on Homelessness Among Veterans, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA 01730, USA; Department of Psychiatry, University of Massachusetts Medical School, 55 N. Lake Ave., Worcester, MA 01655, USA. Electronic address: David.Smelson@umassmed.edu.
authors.forename: David
authors.initials: D
authors.lastname: Smelson
authors.affiliation: Program Evaluation Resource Center, VA Palo Alto Health Care System, 795 Willow Road (152-MPD), Menlo Park, CA 94025, USA. Electronic address: Andrea.Finlay@va.gov.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Oliva
authors.affiliation: Kaiser Permanente Institute for Health Research, 10065 E Harvard Ave., Suite 300, Denver, CO 80231, USA; Division of General Internal Medicine, University of Colorado School of Medicine, 12631 E. 17th Ave., Aurora, CO 80204, USA. Electronic address: Andrea.Finlay@va.gov.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Binswanger
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002047:Buprenorphine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D009271:Naltrexone / Q000627:therapeutic use; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D011330:Prisons; D012189:Retrospective Studies; D012935:Social Justice; D014481:United States; D014493:United States Department of Veterans Affairs / Q000331:legislation & jurisprudence; D014728:Veterans / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data
chemical_list: D000701:Analgesics, Opioid; D002047:Buprenorphine; D009271:Naltrexone; D008691:Methadone
keywords: Buprenorphine; Criminal Justice; Methadone; Opioid-related disorders; United States Department of Veterans Affairs
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