Buprenorphine pharmacotherapy in US veterans with opioid use disorder: an evaluation of therapeutic relationships, telehealth services, treatment retention, and suicide/overdose mortality outcomes

Compared to the general US population, Veterans are at a higher risk for substance disorders such as opioid use disorders (OUD) due to risk factors such as post-traumatic stress disorder, chronic pain, sleep issues, and use of other substances including alcohol or sedatives. Medication-assisted therapies (MAT) serve as an effective treatment option for those with OUD and combine a pharmacological treatment approach through opioid agonist treatment such as buprenorphine or buprenorphine/naloxone with psychological therapies. The key challenge, however, is ensuring appropriate access to care and delivery of these approaches to US Veterans. Veterans more often live in rural areas where the burden of the opioid epidemic has significantly escalated over the last 20 years. Additionally, access to treatment with MAT is a challenge in rural areas, which suggests a significant proportion of Veterans may not be receiving the care they need in a timely fashion. In other chronic disease models, treatment retention and adherence improve when the patient and provider have an existing therapeutic history. Additionally, telehealth services have expanded considerably in recent years for mental health care, and have been recently adopted for MAT and OUD management. The objective of this thesis was to identify the relationships between therapeutic relationships, telehealth, treatment retention, and mortality. The central hypothesis was that existing therapeutic relationships and telehealth utilization during buprenorphine pharmacotherapy for OUD will improve treatment retention, which will subsequently reduce suicide- and overdose-related deaths.