Receipt of medications for opioid use disorder among rural and urban veterans health administration patients

Abstract

Aim: We examined differences in medications for opioid use disorder (MOUD) receipt between rural and urban veteran patients following initiatives within the US Department of Veterans Affairs (VA) to expand access to MOUD. Methods: Data for this retrospective cohort study were obtained from the VA Corporate Data Warehouse, which contains national electronic health record data for all VA patients. The analytic sample included all patients diagnosed with OUD from 10/1/2018–9/30/20. Rurality was identified by the Rural Urban Commuting Area (RUCA) code of patients’ home address. Associations between rurality and MOUD receipt, as well as type of MOUD received, were examined using logistic regression. Results: Among 66,842 patients with OUD, 27.4 % were rural residents. Compared to urban patients, rural patients were slightly younger (50.1 vs. 52.5 years), more often white (87.7 % vs. 70.3 %) and less often received MOUD (42.6 % vs 45.5 %). Multivariable models confirmed that rural patients had a lower likelihood of accessing any form of MOUD (aOR= 0.84, 95 % CI: 0.81–0.87) relative to urban VA patients. Medication-specific analyses identified a lower likelihood of receiving methadone (aOR= 0.36, 95 % CI: 0.33–0.39) and naltrexone (aOR= 0.89, 95 % CI: 0.80–0.99) among rural patients, but higher likelihood of receiving buprenorphine (aOR= 1.05, 95 % CI: 1.01–1.09). Conclusion: Rural VA patients have a lower likelihood of receiving methadone and naltrexone for OUD treatment relative to urban patients, but greater likelihood of receiving buprenorphine. Continued work is needed to ensure that rural Veterans have equitable access to the most appropriate medication for their health care needs.

Keywords

• Rural
• Veterans
• Access
• Opioid agonist
• Opioid use disorder