https://orcid.org/0000-0002-2453-8871
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Abstract
The US is confronted with a rise in opioid use disorder (OUD), opioid misuse, and opioid-associated harms. Medication treatment for opioid use disorder (MOUD)—including methadone, buprenorphine and naltrexone—is the gold standard treatment for OUD. MOUD reduces illicit opioid use, mortality, criminal activity, healthcare costs, and high-risk behaviors. The Veterans Health Administration (VHA) has invested in several national initiatives to encourage access to MOUD treatment. Despite these efforts, by 2017, just over a third of all Veterans diagnosed with OUD received MOUD. VHA OUD specialty care is often concentrated in major hospitals throughout the nation and access to this care can be difficult due to geography or patient choice. Recognizing the urgent need to improve access to MOUD care, in the Spring of 2018, the VHA initiated the Stepped Care for Opioid Use Disorder, Train the Trainer (SCOUTT) Initiative to facilitate access to MOUD in VHA non-SUD care settings. The SCOUTT Initiative’s primary goal is to increase MOUD prescribing in VHA primary care, mental health, and pain clinics by training providers working in those settings on how to provide MOUD and to facilitate implementation by providing an ongoing learning collaborative. Thirteen healthcare providers from each of the 18 VHA regional networks across the VHA were invited to implement the SCOUTT Initiative within one facility in each network. We describe the goals and initial activities of the SCOUTT Initiative leading up to a two-day national SCOUTT Initiative conference attended by 246 participants from all 18 regional networks in the VHA. We also discuss subsequent implementation facilitation and evaluation plans for the SCOUTT Initiative. The VHA SCOUTT Initiative could be a model strategy to implement MOUD within large, diverse health care systems.
Acknowledgements
The authors thank Carrie Edlund, MS for assistance with editing the manuscript. In addition, the authors wish to acknowledge the leadership and collaboration of the following leaders (alphabetically listed) on the SCOUTT Initiative: Lucille Burgo, Melissa Christopher, Steve Hunt, Terri Jorgenson, Jenny Knoeppel, Tera Moore, Andy Pomerantz, Beverly Randolph, Friedhelm Sandbrink, the entire SCOUTT Initiative Planning Committee, and the Veteran Health Administration clinicians who contributed to the vision and success of the implementation of the SCOUTT Initiative.
Disclosure statement
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or any of its academic affiliates.
Author contributions
KD conceived of the SCOUTT Initiative. KD, AG, EH, JB, and HH managed and contributed to the operation of the SCOUTT Initiative. AG, AM, and NC took the lead in writing this manuscript. All authors, AG, KD, EH, JB, NC, AM, MD, and HH, provided critical feedback and contributed to the writing of the manuscript.