Among nearly 24,000 VA patients with opioid use disorder, those with co-occurring cannabis or alcohol use disorders were 20-22% less likely to start medications and 5-6% less likely to continue them.
Read this if you work in addiction medicine or are a veteran with co-occurring substance use issues seeking treatment.
22% less likelyVeterans with cannabis use disorder were 22% less likely to initiate opioid treatment medications
What the researchers found
Among 23,990 VA patients without prior MOUD, only 12% initiated medications in the following year. Cannabis use disorder (aIRR=0.78) and alcohol use disorder (aIRR=0.80) were both negatively associated with initiation. Among 11,854 patients already on MOUD, 83% continued. Cannabis use disorder (aIRR=0.95), alcohol use disorder (aIRR=0.94), and amphetamine/stimulant use disorder (aIRR=0.94) were all negatively associated with continuation.
Why it matters
MOUD (buprenorphine, methadone, naltrexone) is the most effective treatment for opioid use disorder but is underutilized. If co-occurring cannabis or alcohol disorders create barriers to starting or staying on MOUD, addressing these barriers could improve opioid treatment outcomes.
The numbers in context
- 23,990 patients without prior MOUD; 12% initiated
- 11,854 patients with prior MOUD; 83% continued
- Cannabis UD initiation: aIRR=0.78 (95% CI: 0.70-0.87)
- Alcohol UD initiation: aIRR=0.80 (95% CI: 0.72-0.90)
- Cannabis UD continuation: aIRR=0.95 (95% CI: 0.93-0.98)
- Study period: Aug 2016-Jul 2017
How the study worked
Retrospective cohort study using national VA electronic health records. Diagnostic codes for SUDs, prescription fills/clinic visits for MOUD. Adjusted regression models stratified by prior MOUD receipt.
Who was studied
23,990 + 11,854 VA outpatients with opioid use disorder (2016-2017)
What this study cannot tell us
Observational design cannot determine why co-occurring SUDs reduce MOUD receipt. VA population may not generalize to non-veterans. Diagnostic codes may not capture all substance use. Cannot distinguish patient vs provider barriers.
How to read the evidence
Large national VA cohort study with adjusted regression models. Strong sample size and clinical relevance but observational design.
When this study was published
Published in 2023. Uses 2016-2017 VA data during the opioid crisis era.
The bigger picture
Co-occurring substance use disorders are the rule, not the exception, in addiction treatment. If treatment systems inadvertently create barriers for patients with multiple SUDs, they fail the patients who need help most.
Questions still open
- Are providers less likely to prescribe MOUD to patients with co-occurring SUDs?
- Do patients with cannabis use disorder face specific barriers to MOUD access?
- Would integrated treatment programs improve MOUD uptake in patients with multiple SUDs?
Read the original research
Associations Between Distinct Co-occurring Substance Use Disorders and Receipt of Medications for Opioid Use Disorder in the Veterans Health Administration.
Journal of addiction medicine, 17(3), 278-285
Citation
Frost, Madeline C; Hawkins, Eric J; Glass, Joseph E; Hallgren, Kevin A; Williams, Emily C. (2023). Associations Between Distinct Co-occurring Substance Use Disorders and Receipt of Medications for Opioid Use Disorder in the Veterans Health Administration.. Journal of addiction medicine, 17(3), 278-285. https://doi.org/10.1097/ADM.0000000000001095