Social and behavioral determinants of moud utilization and opioid overdose in the US, over 192 people DIE each day due to opioid overdose (OOD), the leading cause of accidental death among adults

Veterans are especially vulnerable to OOD, experiencing rates double those of non-veterans, due to their higher prevalence of opioid use disorder (OUD). Medication treatment for OUD (moud) is the gold standard treatment for opioid use disorder (OUD). However, in the veterans health administration of the department of veterans affairs (VA) and non-VA hospitals, access to moud care is lacking. Compounding poor access, many patients who receive buprenorphine discontinue within 1 year, an indicator of suboptimal treatment retention. Social determinants of health are the conditions in which people are born, live, work, and age. Adverse social determinants of health include job insecurity, housing insecurity, financial insecurity, food insecurity, as well as legal, social/familial, transportation, and violence problems. Together with adverse behavioral health factors such as substance use and mental health disorders (e.g., major depression), adverse social and behavioral determinants of health (sbdh) are associated with poorer health, and concurrent adverse sbdh can have compounding negative health consequences. The overarching goal of this proposal is to understand sbdh, biological variables, clinical settings and clinical factors that impact moud access and outcomes and to develop predictive models for moud outcomes.