Background

The Pharmacist Providers Improve Access for Rural Veterans with Opioid Use Disorder (OUD) Enterprise-Wide Initiative (EWI) has been supported by the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Office of Rural Health (ORH) since 2020. The program increases access to medication treatment for Veterans living with OUD and other Substance Use Disorders (SUD).

This program is also known as MH-REACHES: Mental Health Rural Expansion Access and Coordinated Health Efforts in SUD. It uses a multi dimensional approach to expand access to medication treatment for rural Veterans by integrating Clinical Pharmacist Practitioners (CPPs) into existing collaborative care team models.

CPPs are key members of team-based care and play a critical role in preventing and treating OUD, overdose, and other SUD-related conditions such as unhealthy alcohol use and Alcohol Use Disorder (AUD). Evidence shows that CPPs help increase access to OUD treatment and improve treatment retention.

CPPs improve access by screening Veterans, assessing their needs, and providing ongoing treatment. As VHA health systems work to respond to the opioid epidemic and other addictions, leaders recognize that CPPs are an underused resource and are the medication experts on the team.

This creates a major opportunity to expand CPP services in mental health, pain management, and SUD care, including OUD and AUD. As of February 2022, about 59.7% of rural Veterans with OUD and 87.9% of rural Veterans with AUD were still not receiving treatment, which shows how urgent the need is to increase access.

This initiative focuses on expanding the CPP workforce to reach more rural Veterans. CPPs are embedded in stepped-care teams within Primary Care Mental Health Integration (PCMHI) and Behavioral Health Integration Program (BHIP) clinics, where SUD care is delivered as part of mental health care.

Goals and Objectives

CPPs collaborate with the health care team, Veterans, and caregivers to provide comprehensive medication management for mental health and SUD. This includes medication evaluation, monitoring and adjustment, education, risk mitigation, and management of other health conditions. These efforts support treatment retention and long-term recovery.

Program objectives include:

• Increase rural Veteran access to medication treatment for mental health and SUD by integrating CPPs into team-based care models.
• Strengthen CPP knowledge and skills across different practice settings so they can provide comprehensive medication management to Veterans receiving mental health and SUD care.
• Support delivery of CPP services to rural Veterans through virtual care options such as telephone visits, clinical video telehealth, and VA Video Connect.

Methodology

The program embeds CPPs into PCMHI and BHIP teams to increase access to care, improve quality, and lower the burden on other providers. Key focus areas include:

• Expanding care to rural Veterans.
• Making SUD care a standard part of CPP practice in mental health settings.
• Supporting mental health performance metrics, such as the Psychotropic Drug Safety Initiative.
• Improving safety outcomes, including suicide risk screening, risk mitigation, and overdose prevention.
• Reducing disparities in SUD care.

The program began in Fiscal Year (FY) 2020 and ran through FY 2023 with the first two cohorts of 35 funded CPPs at 34 facilities. In FY 2024, the program continued by funding 28 CPPs across 22 facilities, all integrated into PCMHI and BHIP. In these roles, CPPs provide mental health care that includes a clear SUD care component and the program is planned to continue through FY 2026.

Among the 28 CPPs funded in the current phase:

• 9 CPPs practice in PCMHI.
• 19 CPPs practice in BHIP.

Together, these CPPs form a network of mental health pharmacists who focus on SUD care for rural Veterans within stepped-care and integrated mental health teams.

Impact on Rural Veteran Health

The program has expanded access to evidence-based medication treatment for Veterans with OUD, AUD, and other SUDs, especially those living in rural areas.

• Twenty-eight project-funded CPPs provided care to more than 12,000 Veterans. Over 7,500 of these Veterans (about 63%) were rural. Overall, CPPs completed 117,453 clinical interventions and more than 11,000 SUD patient care visits.
• Fourteen Drug Enforcement Administration (DEA)-registered CPPs from the program prescribed 1,832 controlled substance prescriptions to 488 Veterans, including 1,233 prescriptions to 307 rural Veterans. Buprenorphine for OUD was prescribed to 53 Veterans, including 30 rural Veterans.
• All participating CPPs focus on AUD and OUD medication treatment and provide overdose education and naloxone prescribing.

Key Takeaways

CPPs have had a strong, positive impact on Veterans’ ability to receive timely, high-quality mental health and SUD care. Their work supports major VA priorities, including preventing Veteran suicide, supporting Veterans’ whole health and their families, building a high-reliability health system, and scaling best practices for SUD screening, treatment, and recovery.

• CPP-led SUD care across VHA was recognized with a 2024 American Society of Health-System Pharmacists Best Practices Award for implementing innovative systems that demonstrate best practices in pharmacy.
• To spread best practices and encourage innovation, 234 CPPs attended a 2020 SUD Clinical Pharmacy virtual training that focused on barrier free access to AUD and OUD prevention, medication treatment, recovery, and harm and risk reduction.
• CPPs have become central to SUD care across many practice settings, meeting Veterans when and where they are ready to receive treatment. This large, system-wide training led to a 96% increase—an additional 352 CPPs—providing SUD care from FY 2018 to FY 2024.
• In FY 2024, 718 CPPs provided SUD care to 130,377 Veterans, with more than 43% of visits delivered through virtual care.
• Changes in federal law allowed 162 CPPs with controlled substance prescriptive authority to prescribe buprenorphine. From January 2023 through September 2024, these CPPs treated 2,170 Veterans with OUD at 72 VA facilities.

Veteran stories highlight the real-world impact of CPP care:

• One Veteran in OUD recovery shared that his CPP “goes way above and beyond” with knowledge, caring, and frequent check-ins. He described feeling truly supported and said he always receives his medications quickly and reliably. He believes his CPP genuinely cares and is concerned about him.
• Another Veteran described how his CPP managed all of his medications and understood every part of his situation. He recalled that 18 months earlier he was struggling emotionally, physically, and mentally, and credits his CPP’s support as a turning point in his recovery.
• In one story from the Bath VA, a rural Veteran named Mr. Burger described years of chronic pain and anxiety treated with a dangerous mix of benzodiazepines and opioids. Working with a CPP, he was able to safely reduce and stop these medications. He shared that his ability to compose music returned and that he now feels clearer and happier.
• At the Forest City Community-Based Outpatient Clinic in Asheville, rural Veterans Tim and Andrew both received SUD care from CPPs. Tim’s medical conditions were complicated by cocaine and alcohol use. Andrew received medication treatment for OUD from a CPP with controlled substance prescriptive authority. After seeing friends die from overdoses, Andrew was determined to change his life for his daughter. Both Veterans thanked their CPP for helping them get their lives back on track and live happier lives with family support.

Download the Printable PDF for Healthcare Providers and Researchers.

References

• Internal program data and outcome summaries from MH-REACHES: Clinical Pharmacy Providers and OUD, Veterans Health Administration, Office of Rural Health (2020–2025).

Contact

• Program Contact: Veldana Alliu, Pharm.D., National Program Manager, Clinical Pharmacy Practice Office (CPPO), Pharmacy Benefits Management (PBM), Sierra Pacific Network (VISN 21), Pleasant Hill, CA. veldana.alliu@va.gov
• Program Contact: Tera Moore, Pharm.D., BCACP, National Program Manager, Clinical Pharmacy Practice Office (CPPO), Pharmacy Benefits Management (PBM), VA Central Office, Washington, DC. tera.moore@va.gov
• Funding Acknowledgement: Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, NOMAD #PRFY-00543.
• Suggested Citation: Alliu, V., & Moore, T. (2025). Pharmacist Providers Improve Access for Rural Veterans with Opioid Use Disorder. Department of Veterans Affairs, Veterans Health Administration. Washington, DC: Office of Rural Health.

Rural Health - Navigation

• Office of Rural Health Home page:
  https://www.ruralhealth.va.gov/index.asp
• Enterprise-Wide Initiatives (EWI) page:
  https://www.ruralhealth.va.gov/Enterprise-Wide-Initiatives-EWI.asp
• Veterans Rural Health Resource Centers (VRHRC) page:
  https://www.ruralhealth.va.gov/Veterans-Rural-Health-Resource-Center-VRHRC.asp