Opioid Dependence Treatment in the Emergency Department.

Misconduct-related separations from the military are associated with subsequent adverse civilian outcomes that are of substantial public health concern. 1 We investigated the association between misconduct-related separations and home-lessness among recently returned active-duty military service members. Methods | We analyzed Veterans Health Administration (VHA) data from US active-duty military service members who were (1) separated (end date of last deployment) from the military (2) deployed in Afghanistan or Iraq, and (3) eligible for and subsequently used VHA services. Homelessness was determined by an assignment of " lack of housing " using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code V60.0 during a VHA encounter, by participation in a VHA homelessness program, or both. 2 The US Department of Defense assigns an interservice separation code upon separation from military service. 3,4 These codes were categorized into misconduct (drugs, alcoholism, offenses, infractions, other), disability, early release, disqualified , normal, and other or unknown. To assess the immediate and long-term associations between military misconduct and postdeployment homeless-ness, and address individual variation during follow-up, 3 co-horts were constructed to determine the incidence of homelessness: (1) on the day of the first VHA encounter after). All patients were followed up through April 30, 2012, and were included in a given cohort only if they contributed data for the duration of the period. Using R version 3.2 (R Foundation for Statistical Computing), risk for homelessness as a function of separation category was estimated using logistic regression (2-tailed α≤.05), adjusting for demographic and military service covariates. The University of Utah institutional review board and the Research and Development committee at the VA Salt Lake City Health Care System approved this study with waiver of consent. Results | Of the 448 290 active-duty service members separated during this period, 63.2% were 18-29 years of age, 87.8% were male, and 39.8% were white (Table 1). Homelessness was determined by ICD-9-CM code (43.1%), participation in a home-lessness program (35.2%), or both (27.1%). With 1 744 725 person-years of observation, the overall incidence of home-lessness was 0.3% at time of first VHA encounter (n = 1259), 1.0% within 1 year (n = 4067), and 2.1% within 5 years (n = 3441); the 5-year incidence was significantly higher than at the first encounter or 1 year (P < .001). Although only 5.6% (n = 24 992) separated for misconduct , they represented 25.6% of homeless veterans at first VHA …