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Catalog
35th AM (2025) - Poster Session
Access to Medications for Opioid Use Disorder amon ...
Access to Medications for Opioid Use Disorder among Homeless-experienced Veterans in Permanent Supportive Housing
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Pdf Summary
This national retrospective study analyzed VA data from 2018-2021 for 10,124 homeless-experienced Veterans (HEVs) with Opioid Use Disorder (OUD) who were placed in permanent supportive housing (PSH) through the HUD-VASH program. Medications for Opioid Use Disorder (MOUD)—including buprenorphine, methadone, and naltrexone—are known to reduce overdose risk and improve outcomes, yet only 24% of HEVs in PSH received MOUD within 12 months of housing entry, lower than the 35-38% previously reported for HEVs generally and 40-45% in the broader Veteran population.<br /><br />Multivariable logistic regression identified disparities and predictors of MOUD receipt. Notably, Black HEVs had 45% lower odds of receiving MOUD compared to White Veterans. Older Veterans (ages 55-64 and 65+) had 40-42% lower odds relative to younger Veterans (18-34). Healthcare engagement strongly predicted MOUD uptake: Veterans with at least one substance use disorder (SUD) treatment visit had over five times higher odds of MOUD receipt, and those with frequent mental health visits (top tertile) had 3.3 times higher odds compared to those with fewer visits.<br /><br />The study adjusted for demographics, psychiatric and comorbid conditions, and healthcare utilization patterns, underscoring the influence of both access and systemic factors on MOUD adoption. The findings highlight critical gaps for older Veterans and Veterans of color and emphasize the role of integrated, frequent engagement with healthcare services in increasing MOUD use.<br /><br />The authors recommend implementing low-threshold MOUD access strategies such as mobile units and same-day initiation, along with targeted outreach and culturally tailored, trauma-informed approaches involving peer support to improve equity and uptake among these vulnerable populations. This work was supported by a THRIVE pilot grant and conducted at the VA Greater Los Angeles Healthcare System.
Keywords
Homeless-experienced Veterans
Opioid Use Disorder
Permanent Supportive Housing
HUD-VASH program
Medications for Opioid Use Disorder
MOUD disparities
Black Veterans
Older Veterans
Healthcare engagement
Low-threshold MOUD access
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