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We examine the history of medications (e.g., methadone, buprenorphine, injectable naltrexone) used in the treatment of OUD within VA, document early and ongoing efforts to increase access and build capacity, primarily through the use of buprenorphine, and summarize research examining barriers and facilitators to prescribing and medication receipt. We find that there has been a slow but steady increase in the use of medications for OUD and, despite system-wide mandates and directives, uneven uptake across VA facilities and within patient sub-populations, including some of those most vulnerable. We conclude with recommendations intended to support the greater use of medication for OUD in the future, both within VA as well as other large health care systems.<\/jats:p>","DOI":"10.1080\/08897077.2018.1452327","type":"journal-article","created":{"date-parts":[[2018,3,29]],"date-time":"2018-03-29T11:05:50Z","timestamp":1522321550000},"page":"139-144","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":129,"title":["Medications for Opioid Use Disorder in the Department of Veterans Affairs (Va) Health Care System: Historical Perspective, Lessons Learned, and Next Steps"],"prefix":"10.1177","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4789-4390","authenticated-orcid":false,"given":"Jessica J.","family":"Wyse","sequence":"first","affiliation":[{"name":"VA Portland Health Care System, Portland, OR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2453-8871","authenticated-orcid":false,"given":"Adam J.","family":"Gordon","sequence":"additional","affiliation":[{"name":"VA Salt Lake City Health Care System, Salt Lake City, Utah"},{"name":"University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven K.","family":"Dobscha","sequence":"additional","affiliation":[{"name":"VA Portland Health Care System, Portland, OR"},{"name":"Oregon Health Science University, Portland, OR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin J.","family":"Morasco","sequence":"additional","affiliation":[{"name":"VA Portland Health Care System, Portland, OR"},{"name":"Oregon Health Science University, Portland, OR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Tiffany","sequence":"additional","affiliation":[{"name":"VA Portland Health Care System, Portland, OR"},{"name":"Oregon Health Science University, Portland, OR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Drexler","sequence":"additional","affiliation":[{"name":"Atlanta VA Medical Center, Decatur, GA"},{"name":"Office of Mental Health and Suicide Prevention, Veterans Health Administration, Washington DC"},{"name":"Emory University School of Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friedhelm","family":"Sandbrink","sequence":"additional","affiliation":[{"name":"VA Medical Center Washington DC"},{"name":"Specialty Care Services, Veterans Health Administration, Washington DC"},{"name":"George Washington University, Washington DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Travis I.","family":"Lovejoy","sequence":"additional","affiliation":[{"name":"VA Portland Health Care System, Portland, OR"},{"name":"Oregon Health Science University, Portland, OR"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2018,4,1]]},"reference":[{"key":"e_1_3_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2007.03.010"},{"key":"e_1_3_5_3_1","unstructured":"VA Mental Health Information System Measure Components Summary BETA. https:\/\/spsites.cdw.va.gov\/sites\/OMHO_MHMP\/_layouts\/15\/ReportServer\/RSViewerPage.aspx?rv%3aRelativeReportUrl=\/sites\/OMHO_MHMP\/AnalyticsReports\/MHIS\/MHISSummary.rdl. 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