Assessing the influence of pandemic-era policies on patterns of opioid use disorder care in a national veteran population

University Of Washington, Seattle WA

Investigators

Abstract

Opioid use disorder (OUD) is a prevalent and often life-threatening condition that can be effectively managed with medication-based treatment (MOUD). First-line therapies such as methadone and buprenorphine are known to reduce the risk of overdose and support long-term recovery. However, access to buprenorphine has not been consistent across all patient groups, raising questions about treatment delivery and system-level variability. Buprenorphine may offer advantages for many individuals, including ease of access and reduced treatment burden compared to methadone. During the 2020–2022 national public health emergency, changes in clinical policy allowed for greater flexibility in MOUD delivery, including remote initiation of buprenorphine. These changes created new opportunities to examine whether broader treatment access affected patterns of care for different segments of the population. If such policies yielded uneven benefits, they may have unintentionally reinforced existing gaps in treatment receipt. This project will use mixed methods to assess how variations in MOUD access and retention shifted before and after the implementation of emergency-era policy changes within the Veterans Health Administration (VHA), the largest provider of substance use care in the U.S. The study will focus on patient populations that have previously experienced limited access to buprenorphine, using national electronic health record (EHR) data to examine changes over time and across communities. Additionally, qualitative interviews will explore patient experiences with OUD care and perspectives on how temporary policy changes were implemented in clinical practice. Study aims include: (1) evaluating how medication receipt and retention varied following policy shifts for patients from different demographic groups; (2) examining the influence of community-level factors on treatment trends; and (3) capturing patient lived experiences with care during this transitional period. Sampling for interviews will ensure representation across key characteristics, including medication history and demographic background. Study findings will inform future MOUD policy and clinical implementation efforts aimed at improving treatment consistency and care quality across systems.