Abstract Background Medication treatment of opioid use disorder (MOUD) improves patient outcomes in a variety of settings. However, the presence of medical co-morbidity —including cardiovascular conditions— may influence the initiation of MOUD. Understanding the impacts of cardiovascular conditions on buprenorphine MOUD (B-MOUD) outcomes are crucial for optimizing opioid use disorder (OUD) treatment access and outcomes. Purpose To evaluate the rate and timing of B-MOUD initiation among persons with with OUD and comorbid cardiovascular conditions coronary artery disease (CAD), peripheral vascular disease (PVD), heart failure and stroke and subsequent outcomes. Methods We included Veterans patients diagnosed with OUD from 2014 through 2024, not previously on B-MOUD, using the Department of Veteran Affairs Corporate Data Warehouse. Index date was designated as the first instance of OUD in the study period. Grouping assignment was based on ICD9/10 based historical diagnosis of CAD, PVD, heart failure, or stroke prior to the index date. Each individual’s trajectory was right-censored at the first of: death; December 31, 2023; or a new diagnosis after the index diagnosis. Only buprenorphine formulations indicated for OUD were included; B-MOUD initiations were defined as the date of first B-MOUD prescription after an OUD diagnosis. Cox proportional hazard models were used, adjusting for year of OUD diagnosis, age, sex, race/ethnicity, urban/rural setting; hazards ratios (HR) with 95% confidence intervals are presented. Results Of 137,238 (8.9% women) Veterans with OUD not on B-MOUD, 21,461 (16%) had CAD, 12,354 (9%) had PVD, 9,648 (7%) had heart failure and 8,353 (6%) had stroke. Baseline demographics and comorbidities are presented in table); patients with cardiovascular conditions were older with higher comorbidities. Adjusted Hazard Ratio for B-MOUD initiation was lower for women (0.92; 0.88–0.96), Black (0.54; 0.51–0.56), rural (0.95; 0.92–0.98) and older Veterans (0.97; 0.97–0.97 per additional year of age). Persons with cardiovascular conditions were associated with lower rate of B-MOUD initiation with HR for CAD (0.84; 0.79–0.89), PVD (0.90; 0.83–0.98), heart failure(0.79; 0.69–0.90) and stroke (0.73; 0.65–0.82). Time to B-MOUD after OUD diagnosis for the overall cohort was less than for Veterans with cardiovascular conditions (FIGURE 1). Conclusions We demonstrated lower B-MOUD initiation among women, Black, rural and older patients, and among patients with cardiovascular conditions in a predominantly male Veteran population. These results should inform broad efforts to increase B-MOUD treatment in patients with cardiovascular conditions and, perhaps, in specialty clinical settings.Table 1:Demographics and comorbidities Time from diagnosis to treatment receipt
Manja et al. (2025) studied this question.