Expanded Use of Telehealth Helped Opioid Use Disorder During COVID Pandemic

Federal emergency authorities invoked during the COVID-19 pandemic expanded the use of telehealth for new and continued care. This expansion included the provision of medications for opioid use disorder (MOUD). MOUD is an evidence-based approach for treating individuals with opioid use disorder (OUD), typically using three medications which include methadone, buprenorphine, and extended-release naltrexone. Researchers examined how the facilitated provision of MOUD for OUD treatment affected Medicare beneficiaries before and during the pandemic.

The longitudinal study, published in JAMA Psychiatry, examined data from the U.S. Centers for Medicare & Medicaid Services from September 2018 to February 2021. Medicare fee-for-service beneficiaries 18 years and older with an International Statistical Classification of Diseases, Tenth Revision, Clinical Modification OUD diagnosis were divided into two cohorts for analysis. The pre-pandemic cohort was observed from September 2018 to February 2020 and the COVID-19 pandemic cohort was observed during the pandemic (September 2019 to February 2021). The main outcomes measured included receipt and retention of MOUD, receipt of OUD and behavioral health-related telehealth services, and incidence of medically treated overdose.

The pre-pandemic cohort consisted of 105,240 beneficiaries, of which 58.1% were female, 67.6% were aged 45 to 74 years, and 79.5% were non-Hispanic White. The pandemic cohort was made up of 70,538 beneficiaries. Of the pandemic cohort, 57.1% were female, 66.3% were aged 45 to 74 years, and 79.7% were non-Hispanic White. When compared to the pre-pandemic cohort, a larger percentage of beneficiaries in the pandemic cohort received OUD-related telehealth services (19.6% versus 0.6%), behavioral health-related telehealth services (41% versus 1.9%), and MOUD (12.6% versus 10.8%). During the study period, beneficiaries in both cohorts experienced medically treated overdoses at a comparable rate; the rate in the pre-pandemic cohort was 18.5% compared to 18.4% in the pandemic cohort.

Additionally, receipt of OUD-related telehealth services in the pandemic cohort was associated with lower odds of medically treated overdose (adjusted odds ratio [aOR], 0.67) and increased odds of MOUD retention (aOR, 1.27). Beneficiaries receiving MOUD from opioid treatment programs only (aOR 0.54) and those in the pandemic cohort receiving buprenorphine from pharmacies only (aOR 0.91) had lower odds of medically treated overdose when compared with beneficiaries who did not receive MOUD.

The authors concluded that the expanded use of telehealth and MOUD provisioning improved retention in care and reduced odds of medically treated overdose. They suggest that “strategies to expand provision of MOUD and increase retention in care are urgently needed.”