Veterans Health System Leader and Clinician Perspectives on Expanding Access to Methadone Treatment for Opioid Use Disorder

Objectives: Private methadone treatment paid for by the Department of Veterans Affairs (VA), called community care (CC), and mobile opioid treatment programs (OTPs) are strategies to expand Veteran access to methadone treatment for opioid use disorder. The purpose of this evaluation was to investigate leader and clinician perspectives on these modalities compared with treatment provided directly by VA OTPs. Methods: Semi-structured interviews were conducted with VA OTP leaders and clinicians from 12 of the 33 VA OTP sites nationwide. Participants (N=24) were asked to compare access, quality, and cost of methadone treatment between VA OTPs and CC and asked about the feasibility of deploying mobile OTP services. Two analysts independently coded the transcribed data and used thematic analysis to identify salient themes and representative quotes. Results: VA leaders and clinicians perceived CC to have longer wait times and lower quality care, but expected these services to be less expensive than VA OTPs. Mobile OTP services were viewed as a potential solution to improve access, though concerns were raised about staffing and the reduced availability of wrap-around services. Key considerations for successful mobile OTP implementation included identifying high-need localities, addressing patient needs, and ensuring financial viability. Conclusions: Within and outside VA, there is growing interest in expanding access to medications for OUD, such as methadone. Leaders and clinicians highlighted important access, quality, and cost considerations when exploring innovative treatment modalities for methadone, such as mobile OTP services and CC. Findings from this VA evaluation may guide methadone treatment improvement in other health systems.