Barriers to Community Treatment for Opioid Use Disorders among Rural Veterans

The Veterans Health Administration (VHA) has instituted several national initiatives to increase access to medication for opioid use disorder (MOUD). throughout rural America. The expansion of the MISSON Act’s community care model may prove beneficial, but barriers still constrain widespread community treatment for veterans. The present study illuminates several previously unidentified barriers facing community-based providers who aim to provide MOUD to rural veterans. The primary means of data collection for this study included in-depth interviews with fifty-three non-VHA MOUD providers, thirty-one staff at non-VHA community-based organizations serving veterans, and five VHA behavioral health employees affiliated with the Montana VHA’s substance use disorder program. Staff at non-VHA community-based organizations serving veterans refer veterans to the VHA for MOUD and express a low literacy level about non-VHA MOUD providers. VHA employees favor the VHA for MOUD and lack a network of collaboration with providers at non-VHA community care clinics. Attitudinal and structural barriers constrain veterans’ treatment options within community settings by creating a vacuum of care in the community, whereby all veterans are funneled to the VHA for MOUD. In Montana, only 6 veterans receive MOUD from non-VHA providers, and this reliance on the VHA’s MOUD program constrains access to treatment and the quality-of-care veterans receive.