Whole Health While You Wait: An Emergency Department Alternatives to Opioids Program - Whole Health While You Wait (WHW): Training, Implementing, and Scaling Emergency Department and Inpatient Whole Health and Medication for Opioid Use Disorder Care Nationally This is a three-year initiative to reduce reliance on opioids for pain management by embedding evidence-based, non-pharmacological Whole Health (WH) therapies and medication for opioid use disorder best practices into Veterans Affairs (VA) emergency department (ED) and inpatient care. Led by University of California, Los Angeles, on behalf of the VA Greater Los Angeles Healthcare System with the New Mexico VA Health Care System. The Whole Health While You Wait Initiative (WHW) will: 1) train providers in WH and medication for opioid use disorder; 2) embed a Pain Specialist to deliver Battlefield Acupuncture, guided imagery, and biofeedback at the point of ED contact, and 3) build a national toolkit to scale this model VA-wide with the potential to reach 142 EDs/urgent cares and 6 million Veterans nationwide. The project will be implemented across two VA health care systems: VA Greater Los Angeles Healthcare System (1.4 million Veterans, 11 facilities across a 5-county Southern California region) and New Mexico VA Health Care System (76,862 Veterans, 13 locations across a 14-county region spanning New Mexico, southern Colorado, and West Texas). Implementation sites in Years 1-2 are the West Los Angeles VA Medical Center and Raymond G. Murphy VA Medical Center ED and inpatient units. The combined annual volume of these two ED is 137,033 Veterans (which is the proposed number of Veterans served in Years 1 and 2). We anticipate that at least two additional VA ED will begin implementation, so the total number of Veterans served in Year 3 will be 260,000 (totaling 397,033 Veterans). The population served reflects the general adult Veteran population presenting with a pain-related complaint, ages 18-100+ and is primarily male (89%). Clinically, this population reflects elevated chronic pain, multimorbidity, and substance use disorder risk; nationally, 61% of Veterans receiving VA care have at least one pain diagnosis (most commonly limb/joint, back, neck, abdominal, and neuropathic), and Veterans face twice the overdose death risk of the general population. Only 2% of Veterans with a pain diagnosis are getting WH therapies. This is an important opportunity to leverage evidence-based WH therapies that can provide non-pharmacologic options for pain control for our Veterans. The WHW Program implements two core strategies. An Aim 1 educational campaign trains providers on non-pharmacological WH pain management (Battlefield Acupuncture, guided imagery, biofeedback) and medication for opioid use disorder screening, initiation, and tapering before implementation begins. An Aim 2 multi-site feasibility study embeds a trained Pain Specialist in the ED waiting room to deliver patient-selected interventions in real time, with continuity into the inpatient setting. Aim 3 builds a national implementation toolkit and Resource Center to scale the model to VA's over 140 EDs/Urgent Cares nationwide. Project goals include increasing provider capacity for WH and medication for opioid use disorder care, reducing opioid reliance at first ED contact, and building sustainable, scalable national infrastructure. Measurable objectives include: 90% of providers at both sites completing WH/medication for opioid use disorder training in Year 1; 25% of Veterans with pain-related ED complaints offered a non-pharmacological intervention in Year 2; reduce opioid prescriptions for pain-related ED visits from the baseline in Year 3; and an implementation toolkit disseminated with 20 external VA facilities engaged in consultation by Year 3 - These objectives align with SAMHSA's Strategic Priorities of recovery, innovation, gold-standard science, and access to high-quality services.
