This briefing paper by Human Rights Watch assesses the response of the U.S. Veterans Administration (VA) to veterans struggling with drug and alcohol dependence, with attention to three VA programs that use evidence-based models to prevent overdose, treat opioid dependence, and end chronic homelessness.
Three pilot programs by the Veterans Health Administration (VHA) informed the development of a national overdose education and naloxone distribution program that provides life-saving medication to veterans at high risk of overdose. Naloxone is a medication that can reverse opioid overdose if given to someone in the early stages of an overdose. A second VA program uses methadone and buprenorphine in a medication-assisted therapy for the treatment of opioid dependence. When combined with behavioral therapies, these medications have proven to be the most effective treatment for opioid dependence. The VHA has made progress in giving veterans access to such treatment. A third VA program pertains to housing for drug-dependent veterans. Providing housing is the first step toward stabilizing drug-dependent veterans and surrounding them with supportive services that improve their health and well-being. In 2010, the VA tested the "Housing First" model and found that the pilot program successfully housed chronically homeless veterans, including many with substance use and severe mental health conditions. "Housing First" is now the official policy of the VA's partnership with the U.S. Department of Housing and Urban Development (HUD). Recommendations for expanding and improving these three evidence-based programs are directed to the VA, the VHA, HUD, and the U.S. Congress. Research for this paper was conducted between January and April 2014 and included interviews with dozens of veterans and their advocates, as well as doctors, administrators and social workers from the VHA.
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