Access to Medications for Opioid Use Disorder Among Veterans With Homeless Experience in Permanent Supportive Housing.

IMPORTANCE

Drug overdose is a leading cause of death among US veterans with homeless experience. Medications for opioid use disorder (MOUD) reduce overdose and all-cause mortality, yet receipt remains low among veterans with homeless experience. Identifying factors associated with MOUD receipt in Department of Veterans Affairs (VA) permanent supportive housing (PSH) can inform strategies to support MOUD implementation and advance health equity.

OBJECTIVE

To identify demographic, clinical, and service-related factors associated with MOUD receipt among veterans with homeless experience with opioid use disorder (OUD) in the Housing and Urban Development-VA Supportive Housing (HUD-VASH) program.

DESIGN, SETTING, AND

PARTICIPANTS

This cohort study used linked national VA administrative and electronic health record data. US veterans with OUD entering HUD-VASH between October 1, 2017, and September 30, 2021, were followed up for 12 months after move-in. Eligible participants were diagnosed with OUD as defined by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision criteria within 5 years before or 1 year after move-in. Sequential logistic regression models examined associations between demographic, clinical, and service utilization factors and MOUD receipt. Statistical analyses were conducted between May 2025 and February 2026.

EXPOSURE: Demographic, clinical, and service-related factors.

MAIN OUTCOMES AND MEASURES: Receipt of MOUD (buprenorphine, methadone, or extended-release naltrexone) within 12 months after HUD VASH move-in.

RESULTS

Among 10 110 veterans with OUD, the mean (SD) age was 53.2 (12.0) years (9297 male [92%]; 3211 Black [32%], 606 Hispanic [6%], 5537 White [55%]); 1685 veterans (17%) received MOUD. Older age (age 55 to 64 years: adjusted odds ratio [AOR], 0.52 [0.42-0.64]) and non-Hispanic Black race (AOR, 0.47 [95% CI, 0.40-0.55]) were associated with lower odds of MOUD receipt, while depression (AOR, 1.24 [95% CI, 1.05-1.46]) and greater behavioral health engagement was associated with higher odds of receipt. Having 1 or more instances of inpatient hospitalization was associated with lower odds of MOUD receipt (AOR, 0.74 [95% CI, 0.64-0.87]).

CONCLUSIONS AND RELEVANCE: In this cohort study of veterans with homeless experience with OUD, 1 in 6 veterans received MOUD within a year of entering PSH. Lower rates of MOUD receipt among older veterans and veterans from racial minority groups highlighted persistent inequities, regardless of housing status.