Veterans Health Administration’s Stimulant Safety Initiative: Increasing Implementation of Evidence-Based Treatments and Overdose Education and Naloxone Distribution

The dramatic rise in stimulant-related overdose deaths (https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm), including among Veterans (https://doi.org/10.1016/j.drugalcdep.2022.109296; https://onlinelibrary.wiley.com/doi/epdf/10.1111/add.15714), has led the Veterans Health Administration (VHA) to employ a national Stimulant Safety Initiative. On October 15, 2021, VHA released a memorandum “Implementation of the Psychotropic Drug Safety Initiative (PDSI) Phase 5: Stimulant Safety Initiative” with the goals of ensuring guideline-concordant treatment of Veterans with stimulant use disorder and the safe and appropriate prescribing of stimulant medications. Built upon the successes of previous PDSI phases/campaigns (e.g., improving medication treatment for opioid use disorder and alcohol use disorder) the Stimulant Safety Initiative employs a stepped approach to implementation over three years (January 2022-December 2024). Step 1 spans the first year and focuses on increasing capacity to deliver guideline-concordant care to patients with stimulant use disorder (i.e., Cognitive-Behavioral Therapy for Substance Use Disorder [CBT-SUD] and Contingency Management [CM]) and expand Overdose Education and Naloxone Distribution (OEND) to patients with stimulant use disorder. Step 2 spans the latter two years and focuses on increasing the number of Veterans receiving CBT-SUD and CM and ensuring safe and appropriate prescribing of stimulant medications while NOT inducing inappropriate tapering of stimulants or avoiding stimulant starts in patients with an appropriate treatment indication.

This session will describe lessons learned and effective strategies, tools, and resources for employing a Stimulant Safety Initiative in healthcare settings. VHA’s efforts will be informative to healthcare systems grappling with how to improve care for patients with stimulant use disorder and how to improve stimulant prescribing and safety more broadly.