Buprenorphine Opioid Treatment During the COVID-19 Pandemic

Abstract

To the Editor To our knowledge, Nguyen et al 1 were the first group to report on the consequences of enabling telehealth initiation of buprenorphine for management of opioid use disorders (OUDs) during the COVID-19 crisis. We read with much excitement their results, which showed a plateau in buprenorphine prescriptions while overall drug prescriptions declined between March 2020 and June 2020. We believe that the trends they report shed light both on the boon of flexible prescription via telehealth and on some potential oversights to address moving forward. These include ensuring treatment initiation and continuation for the most vulnerable patients, who might not have access to telehealth, and surveilling access to other OUD medications through the pandemic.First, while the authors conclude that the change in policy could have allowed for retention in buprenorphine treatment, this might be a trade off between insured and uninsured patients. That is, while insured patients seem to continue treatment using telehealth, cash payers were the only ones to see their number for buprenorphine prescriptions decline significantly as compared with Medicare, Medicaid and commercial plans (Figure 2 1 and Table 1 ). Cash payers might encompass a subpopulation most vulnerable to the effects of this double pandemic. Among those most affected financially or otherwise by the pandemic (interruption of services, financial crises, etc) are users of multiple substances, 2 those of lower socioeconomic status, those newly released from incarceration as part of the current decarceration efforts, and those dependent on now-fractured community safety nets. 3 Among those also excluded from the new telemedicine policies are patients with OUD who rely on in-person methadone clinics. To complement the work done by Nguyen et al, 1 it would also be worthwhile to analyze how COVID-19 has affected the 350 000 Americans receiving methadone treatment. 4 To better understand the impact of COVID-19 on restricting access to opioid treatment, future studies may wish to explore trends in other treatment modalities which require in-person monitoring.In conclusion, Nguyen et al 1 present an interesting first evaluation of recent policy efforts to facilitate OUD management in the wake of the ongoing COVID-19 pandemic. As they report, increases in the flexibility of prescription via telemedicine is invaluable to promote retention of patients in treatment and improve drug compliance. This will surely extend past the current pandemic to include, for example, individuals living in rural areas or seeking an accelerated consultation. However, these trends seem to suggest other strategies will be necessary to prevent the most vulnerable individuals from falling through the cracks.