Telemedicine Use and Quality of Opioid Use Disorder Treatment in the US During the COVID-19 Pandemic

Abstract

ImportanceLittle is known about the potential implications of the rapid transition to telehealth during the COVID-19 pandemic for treatment of opioid use disorder (OUD).ObjectiveTo examine the association between telemedicine adoption during the COVID-19 pandemic and indicators of OUD treatment quality.Design, Setting, and ParticipantsThis cohort study analyzed deidentified administrative claims data from OptumLabs Data Warehouse. Claims for telemedicine visits were included for both the prepandemic period (March 14, 2019, to March 13, 2020) and pandemic period (March 14, 2020, to March 13, 2021). Patients with OUD and continuous enrollment in either commercial insurance or Medicare Advantage plans were included. Clinicians who provided office-based OUD care were included and categorized into low, medium, or high telemedicine use groups. Patients were attributed to the clinician (and corresponding telemedicine use group) from whom they received a plurality of OUD visits.Main Outcomes and MeasuresThe 4 outcomes were all outpatient visits, OUD visits (in person vs telemedicine) within 90 days of an index visit, medications for OUD (MOUD) prescribing, and OUD-related clinical events (including drug overdose, inpatient detoxification and rehabilitation center stay, or injection drug use–related infections).ResultsThe analysis included 11 801 patients (mean [SD] age, 53.9 [15.7] years; 5902 males [50.0%]) who were treated by 1768 clinicians. Clinicians with low vs high telemedicine use conducted a mean (SD) of 2.1% (2.5%) vs 69.5% (18.6%) of their office visits virtually in the pandemic period. While telemedicine use for OUD increased significantly from the prepandemic to pandemic periods, total OUD visit volume (in person plus telemedicine) per patient episode remained stable among both high (2.6 to 2.7 visits per patient episode) and low (3.1 to 3.3 visits per patient episode) telemedicine use groups. In adjusted analyses comparing the prepandemic with pandemic periods, there was no differential change in MOUD initiation (adjusted odds ratio [OR], 1.00; 95% CI, 0.84-1.19), MOUD days’ supply (differential change in days’ supply, –0.27; 95% CI, –1.84 to 1.30), or OUD-related clinical events (adjusted OR, 1.01; 95% CI, 0.73-1.24) among patients who were treated by clinicians in low vs high telemedicine use groups.Conclusions and RelevanceResults of this study revealed that clinical outcomes were similar among patients who were treated by clinicians with high and low telemedicine use during the COVID-19 pandemic, suggesting that telemedicine is a comparable alternative to in-person OUD care. There was no evidence that telemedicine was associated with increased access to or improved quality of OUD treatment.

A telemedicine bridge clinic improves access and reduces cost for opioid use disorder care

“…During the COVID-19 pandemic, temporary Drug Enforcement Administration (DEA) rules suspending in-person evaluation requirements for the initiation of controlled substance treatments, including both audio and audiovisual buprenorphine prescribing, allowed for expansion of bridge clinic services to a virtual environment ( Second Temporary Extension ). Buprenorphine therapy for OUD provided through a telemedicine platform can overcome some treatment obstacles, improve care engagement and retention, decrease overdose and mortality rates, and lower health care cost ( Hailu et al, 2023 , Guillen et al, 2021 , Jones et al, 2022 , Jones et al, 2023 ). Bridge clinics, especially those using telemedicine, can serve as a safety net to close gaps in the continuum of care which may arise for myriad reasons and cause diminished access to proven lifesaving care.…”

Care coordination between rural primary care and telemedicine to expand medication treatment for opioid use disorder: Results from a single‐arm, multisite feasibility study

“…[5][6][7][8][9][10] Studies comparing in-person and TM-based MOUD generally showed comparable effectiveness and even better retention outcomes in TM-based MOUD. [11][12][13] According to a recent study, the policy changes supportive of TM implemented during the COVID-19 pandemic had a positive effect on the access to health care and clinical outcomes of rural patients with OUD. 14 Thus, the provision of MOUD services via TM is a promising approach to quickly expand OUD treatment access in rural areas.…”

“…Rural communities are of particular concern because they are disproportionately impacted by opioid use disorder (OUD) and encounter many challenges to accessing MOUD (eg, limited availability of MOUD services, economic distress, older populations, social isolation, and travel burden) 5–10 . Studies comparing in‐person and TM‐based MOUD generally showed comparable effectiveness and even better retention outcomes in TM‐based MOUD 11–13 . According to a recent study, the policy changes supportive of TM implemented during the COVID‐19 pandemic had a positive effect on the access to health care and clinical outcomes of rural patients with OUD 14 .…”

An Assessment of the One-Month Effectiveness of Telehealth Treatment for Opioid Use Disorder Using the Brief Addiction Monitor

“…2 The convenience of telehealth combined with the ability to obtain the prescription at a pharmacy is notable 3 and telehealth services have proliferated in response. 4,5 Prior studies evaluating the efficacy of teleMOUD are largely limited to descriptive articles and studies reporting rates of treatment retention. The results of these studies have so far been promising and suggest that teleMOUD is associated with significantly higher rates of retention.…”

“…2 The convenience of telehealth combined with the ability to obtain the prescription at a pharmacy is notable 3 and telehealth services have proliferated in response. 4,5…”