An examination of telehealth policy impacts on initial rural opioid use disorder treatment patterns during the COVID‐19 pandemic

Abstract

Purpose Tracking changes in care utilization of medication for opioid use disorder (MOUD) services before, during, and after COVID‐19‐associated changes in policy and service delivery in a mixed rural and micropolitan setting. Methods Using a retrospective, open‐cohort design, we examined visit data of MOUD patients at a family medicine clinic across three identified periods: pre‐COVID, COVID transition, and COVID. Outcome measures include the number and type of visits (in‐person or telehealth), the number of new patients entering treatment, and the number of urine drug screens performed. Distance from patient residence to clinic was calculated to assess access to care in rural areas. Goodness‐of‐Fit Chi‐Square tests and ANOVAs were used to identify differences between time periods. Findings Total MOUD visits increased during COVID (436 pre vs. 581 post, p < 0.001), while overall new patient visits remained constant (33 pre vs. 29 post, p = 0.755). The clinic's overall catchment area increased in size, with new patients coming primarily from rural areas. Length of time between urine drug screens increased (21.1 days pre vs. 43.5 days post, p < 0.001). Conclusions The patterns of MOUD care utilization during this period demonstrate the effectiveness of telehealth in this area. Policy changes allowing for MOUD to be delivered via telehealth, waiving the need for in‐person initiation of MOUD, and increased Medicaid compensation for MOUD may play a valuable role in improving access to MOUD during the COVID‐19 pandemic and beyond.

Assessing the impact of social distancing measures implemented during COVID-19 pandemic on medications for opioid use disorder in West Virginia

“…This change rebound in prescription supports that despite the COVID-19 pandemic and social distancing requirements, with policy adjustments and clinical practice evolution, prescribers in WV were only temporarily inhibited in the distribution of MOUD. This rebound in prescribing, after telemedicine and social distancing measures are put in place, can be expected as previous studies on telemedicine delivery of MOUD show improved retention of patients with OUD ( Hughes et al, 2021 ; Wang et al, 2021 ).…”

“…Telemedicine is effective for opioid agonist therapy delivery ( Morin, Parrotta, Eibl, & Marsh, 2021 ), including the induction of therapy ( Tofighi et al, 2019 ). Hughes and colleagues, report that primary care-based MOUD visits increased with telehealth ( Hughes et al, 2021 ). A phone-based MOUD telehealth program was similarly effective in San Francisco ( Mehtani et al, 2021 ).…”

“…As a result, medical facilities may have experienced gaps in care due to social distancing measures. Although, an increase in care delivery due to telemedicine reach to marginalized populations, may also be found ( Hughes, Verrastro, Fusco, Wilson, & Ostrach, 2021 ).…”

The Impact of the COVID-19 Pandemic on Drug Use Behaviors, Fentanyl Exposure, and Harm Reduction Service Support among People Who Use Drugs in Rural Settings

“…Research on how programs may leverage these strengths to expand scopes of service in the pandemic era should be prioritized. For example, the success of telemedicine in providing opioid use disorder treatment in rural areas [ 32 ], in concert with evolving policies related to reimbursement, provides an opportunity to explore how novel mobile and other low-threshold care may be linked to or delivered through harm reduction programs. Given high rates of governmental distrust in people who use drugs, particularly those in rural communities, harm reduction service providers as trusted messengers could be empowered to provide public health messaging around COVID-19 information and vaccination [ 33 , 34 ].…”

Changes in methadone take-home dosing before and after COVID-19

“…This study adds to the growing body of research examining the impact of SAMHSA exemptions implemented during the COVID-19 pandemic. Research has reported positive outcomes from post-COVID telemedicine buprenorphine-based treatment programs made possible through loosened restrictions (Hughes et al, 2021;Tofighi et al, 2021). Regulatory bodies were concerned with increase diversion as a result of increases in take home methadone doses.…”