Adaptations to Opioid Use Disorder Care During the COVID-19 Pandemic: A National Survey of Prescribers

Abstract

Objectives: Among opioid use disorder (OUD)-treating providers, to characterize adaptations used to provide medications for OUD (MOUD) and factors associated with desire to continue virtual visits post-COVID-19 pandemic. Methods: In a national electronic survey of OUD-treating prescribers (July-August 2020), analyses restricted to X-waivered buprenorphine prescribers providing outpatient, longitudinal care for adults with OUD, quantitative and qualitative analyses of survey items and free text responses were conducted. Results: Among 797 respondents, 49% were men, 57% ≥50 years, 76% White, 68% physicians. Respondents widely used virtual visits to continue prescribing existing MOUD regimens (79%), provide behavioral healthcare (71%), and initiate new MOUD prescriptions (49%). Most prescribers preferred to continue/expand use of virtual visits after COVID-19. In multivariable models, factors associated with preference to continue/expand virtual visits to initiate MOUD postpandemic were treating a moderate number of patients prepandemic (aOR = 1.67; 95%[CI] = 1.06,2.62) and practicing in an urban setting (aOR = 2.17; 95%[CI] = 1.48,3.18). Prescribing buprenorphine prepandemic (aOR = 2.06; 95%[CI] = 1.11,3.82) and working in an academic medical center (aOR = 2.47; 95%[CI] = 1.30,4.68) were associated with preference to continue/expand use of virtual visits to continue MOUD postpandemic. Prescribing naltrexone extended-release injection prepandemic was associated with preference to continue/expand virtual visits to initiate and continue MOUD (aOR = 1.51; 95%[CI] = 1.10,2.07; aOR = 1.74; 95%[CI] = 1.19,2.54). Qualitative findings suggest that providers appreciated virtual visits due to convenience and patient accessibility, but were concerned about liability and technological barriers. Conclusions: Surveyed prescribers widely used virtual visits to provide MOUD with overall positive experiences. Future studies should evaluate the impact of virtual visits on MOUD access and retention and clinical outcomes.

Pandemic telehealth flexibilities for buprenorphine treatment: A synthesis of evidence and policy implications for expanding opioid use disorder care in the U.S

“…29 Other surveys and interviews of providers similarly found significant uptake of telehealth for buprenorphine among prescribers. 27,28,30,31 Trends in uptake of telehealth varied across different types of programs offering buprenorphine: A survey of 57 primary care practices found that 92.3% were conducting initiation visits via telehealth, 32 and a survey of 325 syringe service programs (SSPs) found that a quarter were initiating buprenorphine via telehealth. 33 In a survey of OTP directors in Pennsylvania, 40% (8) offered video appointments and 50% (10) offered telephone appointments for buprenorphine follow-up visits, but only 25% (5) and 10% (2) respectively did so for initiation.…”

“…37,38 Others offered patients the option to access remote technologies from a clinic to communicate with a prescriber if they did not have access to personal technologies for telehealth visits. 50 Others shifted psychosocial services to virtual platforms, 51 discontinued or required less frequent drug screening, 28,29,32,37,41,51,52 or required less frequent psychosocial service utilization. 29,51 Some practices offered longer days-supply to reduce burden, 29,32,37,51 while others offered shorter days-supply to encourage more frequent checkins.…”

“…Buprenorphine prescribers generally supported the ability to prescribe buprenorphine via telehealth, with most expressing few to no challenges. 27,28,30,31,57 Some even noted that they observed better engagement and retention in treatment. 32 Other observed benefits to patient care included having a better understanding of patients' lives by being able to see into their homes; reduced burden of patient surveillance from fewer in-person visits and urine drug screens; reduced crowding and exposure to COVID-19; reduced burden of seeing people or places associated with past drug use or trauma; and reduced transportation challenges for those who live in rural areas or have competing responsibilities like work and childcare.…”

“…For example, in one study, prescribers working in an OTP were less likely than prescribers working in other settings to prefer telehealth visits. 28 In a study of buprenorphine prescribers, those with fewer OUD patients were less likely to report feeling comfortable treating patients via telehealth. 26…”

Treatment utilization and modality preference among veterans receiving outpatient substance use disorder treatment during a pandemic

“…Authors concluded that SUD treatment via telehealth is promising, but must be studied further. 14 In the context of this sudden shift in modality, as well as early indications that providers working in SUD treatment settings may prefer to continue to offer telemedicine after the effects of the pandemic decrease, 15 it is imperative to examine how use of telehealth affects treatment engagement and outcome. 1 A survey of SUD treatment providers indicated that video was considered to be the preferred telehealth method, though telephone was considered to be more accessible.…”