Screening for homelessness among individuals initiating medication-assisted treatment for opioid use disorder in the Veterans Health Administration


  • Marcus A. Bachhuber, MD, MSHP
  • Christopher B. Roberts, MPH
  • Stephen Metraux, PhD
  • Ann Elizabeth Montgomery, PhD



homelessness, heroin dependence, opiate dependence, methadone, buprenorphine


Objective: To determine the prevalence of homelessness and risk for homelessness among veterans with opioid use disorder initiating treatment.

Setting: Addiction treatment programs operated by the US Department of Veterans Affairs (VA).

Participants: All veterans initiating treatment with methadone or buprenorphine for opioid use disorder between October 1, 2013 and September 30, 2014 (n = 2,699) who were administered the VA’s national homelessness screener.

Main outcome measures: Self-reported homelessness or imminent risk of homelessness.

Results: The prevalence of homelessness was 10.2 percent and 5.3 percent were at risk for homelessness. Compared to male veterans, women veterans were less likely to report homelessness (8.9 percent vs 10.3 percent) but more likely to be at risk (11.8 percent vs 4.9 percent). By age group, veterans aged 18-34 and 45-54 years most frequently reported homelessness (12.0 and 11.7 percent, respectively) and veterans aged 45-54 and 55-64 years most frequently reported risk for homelessness (6.5 and 6.8 percent, respectively).

Conclusions: The prevalence of homelessness in this population is approximately 10 times that of the general veteran population accessing care at VA. Screening identified a substantial number of veterans who could benefit from VA housing assistance and had not received it recently. Programs to address veteran homelessness should engage with veterans seeking addiction treatment. Integration of homelessness services into addiction treatment settings may, in turn, improve outcomes.

Author Biographies

Marcus A. Bachhuber, MD, MSHP

Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania.

Christopher B. Roberts, MPH

Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania

Stephen Metraux, PhD

National Center on Homelessness Among Veterans, US Department of Veterans Affairs, Philadelphia, Pennsylvania; Department of Health Policy and Public Health, University of the Sciences, Philadelphia, Pennsylvania

Ann Elizabeth Montgomery, PhD

National Center on Homelessness Among Veterans, US Department of Veterans Affairs, Philadelphia, Pennsylvania.


Tsai J, Rosenheck RA: Risk factors for homelessness among US veterans. Epidemiol Rev. 2015; 37: 177-195.

North CS, Pollio DE, Smith EM, et al.: Correlates of early onset and chronicity of homelessness in a large urban homeless population. J Nerv Ment Dis. 1998; 186: 393-400.

Caton CL, Hasin D, Shrout PE, et al.: Risk factors for homelessness among indigent urban adults with no history of psychotic illness: A case-control study. Am J Public Health. 2000; 90: 258-263.

Thompson RG Jr, Wall MM, Greenstein E, et al.: Substanceuse disorders and poverty as prospective predictors of first-time homelessness in the United States. Am J Public Health. 2013; 103(suppl 2): S282-S288.

Byrne T, Montgomery AE, Dichter ME: Homelessness among female veterans: A systematic review of the literature. Women Health. 2013; 53: 572-596.

Banta-Green CJ, Maynard C, Koepsell TD, et al.: Retention in methadone maintenance drug treatment for prescriptiontype opioid primary users compared to heroin users. Addiction. 2009; 104: 775-783.

Shah NG, Galai N, Celentano DD, et al.: Longitudinal predictors of injection cessation and subsequent relapse among a cohort of injection drug users in Baltimore, MD, 1988-2000. Drug Alcohol Depend. 2006; 83: 147-156.

Lundgren LM, Sullivan LM, Maina AW, et al.: Client factors associated with length of stay in methadone treatment among heroin users who inject drugs: Quantitative analysis of state-level substance abuse treatment utilization data. J Addict Med. 2007; 1: 26-32.

Alford DP, LaBelle CT, Richardson JM, et al.: Treating homeless opioid dependent patients with buprenorphine in an office-based setting. J Gen Intern Med. 2007; 22: 171-176.

Montgomery AE, Fargo JD, Kane V, et al.: Development and validation of an instrument to assess imminent risk of homelessness among veterans. Public Health Rep. 2014; 129: 428-436.

Office of the Secretary, US Department of Veterans Affairs: Strategic Plan. Washington, DC: Office of Policy and Planning, US Department of Veterans Affairs, June 2010.

Mancino M, Curran G, Han X, et al.: Predictors of attrition from a national sample of methadone maintenance patients. Am J Drug Alcohol Abuse. 2010; 36: 155-160.

Montgomery AE, Fargo JD, Byrne TH, et al.: Universal screening for homelessness and risk for homelessness in the Veterans Health Administration. Am J Public Health. 2013; 103(suppl 2): S210-S211.



How to Cite

Bachhuber, MD, MSHP, M. A., C. B. Roberts, MPH, S. Metraux, PhD, and A. E. Montgomery, PhD. “Screening for Homelessness Among Individuals Initiating Medication-Assisted Treatment for Opioid Use Disorder in the Veterans Health Administration”. Journal of Opioid Management, vol. 11, no. 6, Nov. 2015, pp. 459-62, doi:10.5055/jom.2015.0298.