{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T17:27:51Z","timestamp":1784136471777,"version":"3.55.0"},"reference-count":28,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T00:00:00Z","timestamp":1678665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Safer opioid prescribing patterns, naloxone distribution, and medications for opioid use disorder (M\u2010OUD) are an important part of decreasing opioid\u2010related adverse events. Veterans are more likely to experience these adverse events compared to the general population. Despite treatment guidelines and ED\u2010based opioid safety programs implemented throughout Veterans Affairs (VA) Medical Centers, many Veterans with OUD do not receive these harm reduction interventions. Prior research in other health care settings has identified barriers to M\u2010OUD initiation and naloxone distribution; however, little is known about how this may be similar or different for health care professionals in VA ED and urgent care centers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted qualitative interviews with VA health care professionals and staff using a semistructured interview guide. We analyzed the data addressing barriers and facilitators to M\u2010OUD treatment in the ED and naloxone distribution using descriptive matrix analysis, followed by team consensus.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We interviewed 19 VA staff in various roles. Respondent concerns and considerations regarding the initiation of M\u2010OUD in the ED included M\u2010OUD initiation falling outside of ED's scope of providing acute treatment, lack of VA\u2010approved M\u2010OUD protocols and follow\u2010up procedures, staffing concerns, and educational gaps. Respondents reported that naloxone was important but lacked clarity on who should prescribe it. Some respondents stated that an automated system to prescribe naloxone would be helpful, and others felt that it would not offer needed support and education to patients. Some respondents reported that naloxone would not address opioid misuse, which other respondents felt was a belief due to stigma around substance use and lack of education about treatment options.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our VA\u2010based research highlights similarities of barriers and facilitators, seen in other health care settings, when implementing opioid safety initiatives. Education and training, destigmatizing substance use disorder care, and leveraging technology are important facilitators to increasing access to lifesaving therapies for OUD treatment and harm reduction.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14683","type":"journal-article","created":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T15:20:42Z","timestamp":1675956042000},"page":"289-298","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Barriers and facilitators to implementing medications for opioid use disorder and naloxone distribution in <scp>Veterans Affairs<\/scp> emergency departments"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9922-6637","authenticated-orcid":false,"given":"Comilla","family":"Sasson","sequence":"first","affiliation":[{"name":"VA Eastern Colorado Health Care System, Veterans Health Administration  Aurora Colorado USA"},{"name":"University of Colorado Anschutz Medical Campus  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7716-5602","authenticated-orcid":false,"given":"Nathalie","family":"Dieujuste","sequence":"additional","affiliation":[{"name":"VA Eastern Colorado Health Care System, Veterans Health Administration  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Klocko","sequence":"additional","affiliation":[{"name":"VA Eastern Colorado Health Care System, Veterans Health Administration  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0460-3701","authenticated-orcid":false,"given":"Zahir","family":"Basrai","sequence":"additional","affiliation":[{"name":"VA Greater Los Angeles Health Care System Department of Emergency Medicine, Veterans Health Administration  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Celedon","sequence":"additional","affiliation":[{"name":"VA Greater Los Angeles Health Care System Department of Emergency Medicine, Veterans Health Administration  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2696-2630","authenticated-orcid":false,"given":"Jonie","family":"Hsiao","sequence":"additional","affiliation":[{"name":"VA Greater Los Angeles Health Care System Department of Emergency Medicine, Veterans Health Administration  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julianne","family":"Himstreet","sequence":"additional","affiliation":[{"name":"National Academic Detailing Services Veterans Health Administration  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Hoffman","sequence":"additional","affiliation":[{"name":"VISN 19 Academic Detailing, Veterans Health Administration  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cassidy","family":"Pfaff","sequence":"additional","affiliation":[{"name":"VISN 19 Academic Detailing, Veterans Health Administration  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Malmstrom","sequence":"additional","affiliation":[{"name":"National Academic Detailing Services Veterans Health Administration  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Smith","sequence":"additional","affiliation":[{"name":"VISN 19 Academic Detailing, Veterans Health Administration  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariel","family":"Holstein","sequence":"additional","affiliation":[{"name":"Pitkin County Public Health  Aspen Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Johnson\u2010Koenke","sequence":"additional","affiliation":[{"name":"VA Eastern Colorado Health Care System, Veterans Health Administration  Aurora Colorado USA"},{"name":"University of Colorado Anschutz Medical Campus  Aurora Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,3,13]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"CarrollJJ GreenTC NoonanRK.Evidence\u2010based strategies for preventing opioid overdose: what's working in the United States.National Center for Injury Prevention and Control Centers for Disease Control and Prevention U.S. Department of Health and Human Services.2018. Accessed December 31 2022.http:\/\/www.cdc.gov\/drugoverdose\/pdf\/pubs\/2018\u2010evidence\u2010based\u2010strategies.pdf"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.3474"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2020.06.049"},{"key":"e_1_2_10_5_1","unstructured":"Initiating buprenorphine treatment in the emergency department.National institute on Drug Abuse.2019. Accessed December 31 2022.https:\/\/nida.nih.gov\/nidamed\u2010medical\u2010health\u2010professionals\/discipline\u2010specific\u2010resources\/emergency\u2010physicians\u2010first\u2010responders\/initiating\u2010buprenorphine\u2010treatment\u2010in\u2010emergency\u2010department"},{"key":"e_1_2_10_6_1","unstructured":"Buprenorphine. Substance Abuse and Mental Health Services Administration. Accessed December 31 2022.https:\/\/www.samhsa.gov\/medication\u2010assisted\u2010treatment\/medications\u2010counseling\u2010related\u2010conditions\/buprenorphine"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/emp2.12409"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.4561"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2019.11.44382"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.9778\/cmajo.20200190"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1080\/07853890.2022.2092896"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2017.0147"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2018.08.044"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.13980"},{"issue":"1","key":"e_1_2_10_16_1","first-page":"16","article-title":"Social constructivism","volume":"1","author":"Kim B","year":"2001","journal-title":"Emerg Perspect Learn Teach Technol"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1177\/104973230201200611"},{"key":"e_1_2_10_18_1","volume-title":"Qualitative Inquiry & Research Design: Choosing among Five Approaches","author":"Creswell JW","year":"2007"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2007.04569.x"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1080\/08897077.2020.1787299"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2020.108146"},{"key":"e_1_2_10_22_1","unstructured":"Whole health library: substance abuse.U.S. Department of Veterans Affairs 2021. Accessed December 31 2022.https:\/\/www.va.gov\/WHOLEHEALTHLIBRARY\/tools\/substance\u2010use\u2010disorders.asp"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.7326\/m21\u20104011"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnx203"},{"key":"e_1_2_10_25_1","volume-title":"Motivational Interviewing: Helping People Change","author":"Miller WR","year":"2013"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1213\/ane.0000000000005976"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.14002"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2022.05.010"},{"key":"e_1_2_10_29_1","unstructured":"What is the U.S. opioid epidemic? U.S. Department of Health and Human Services. October 27 2021. Accessed December 31 2022.https:\/\/www.hhs.gov\/opioids\/index.html"}],"container-title":["Academic Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.14683","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/acem.14683","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.14683","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T02:21:50Z","timestamp":1692584510000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acem.14683"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,13]]},"references-count":28,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,4]]}},"alternative-id":["10.1111\/acem.14683"],"URL":"https:\/\/doi.org\/10.1111\/acem.14683","archive":["Portico"],"relation":{},"ISSN":["1069-6563","1553-2712"],"issn-type":[{"value":"1069-6563","type":"print"},{"value":"1553-2712","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,13]]},"assertion":[{"value":"2022-09-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-03","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-03-13","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}