Mobile Telemedicine for Buprenorphine Treatment in Rural Populations With Opioid Use Disorder

Abstract

IMPORTANCE The demand for medications for opioid use disorder (MOUD) in rural US counties far outweighs their availability. Novel approaches to extend treatment capacity include telemedicine (TM) and mobile treatment on demand; however, their combined use has not been reported or evaluated. OBJECTIVE To evaluate the use of a TM mobile treatment unit (TM-MTU) to improve access to MOUD for individuals living in an underserved rural area. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study evaluated data collected from adult outpatients with a diagnosis of OUD enrolled in the TM-MTU initiative from February 2019 (program inception) to June 2020. Program staff traveled to rural areas in a modified recreational vehicle equipped with medical, videoconferencing, and data collection devices. Patients were virtually connected with physicians based more than 70 miles (112 km) away. Data analysis was performed from June to October 2020. INTERVENTION Patients received buprenorphine prescriptions after initial teleconsultation and follow-up visits from a study physician specialized in addiction psychiatry and medicine. MAIN OUTCOMES AND MEASURES The primary outcome was 3-month treatment retention, and the secondary outcome was opioid-positive urine screens. Exploratory outcomes included use of other drugs and patients' travel distance to treatment. RESULTS A total of 118 patients were enrolled in treatment, of whom 94 were seen for follow-up treatment predominantly (at least 2 of 3 visits [>50%]) on the TM-MTU; only those 94 patients' data are considered in all analyses. The mean (SD) age of patients was 36.53 (9.78) years, 59 (62.77%)were men, 71 (75.53%) identified as White, and 90 (95.74%) were of non-Hispanic ethnicity. Fiftyfive patients (58.51%) were retained in treatment by 3 months (90 days) after baseline. Opioid use was reduced by 32.84% at 3 months, compared with baseline, and was negatively associated with treatment duration (F = 12.69; P = .001). In addition, compared with the nearest brick-and-mortar treatment location, TM-MTU treatment was a mean of 6.52 miles (range, 0.10-58.70 miles) (10.43 km; range, 0.16-93.92 km) and a mean of 10 minutes (range, 1-49 minutes) closer for patients. CONCLUSIONS AND RELEVANCEThese data demonstrate the feasibility of combining TM with mobile treatment, with outcomes (retention and opioid use) similar to those obtained from officebased TM MOUD programs. By implementing a traveling virtual platform, this clinical paradigm not only helps fill the void of rural MOUD practitioners but also facilitates access to underserved (continued) Key Points Question Can medications to treat opioid use disorder be effectively provided to individuals living in underserved rural areas via telemedicine in a mobile treatment unit? Findings In this quality improvement study, comparable to office-based telemedicine programs, 58.51% of patients treated in a mobile telemedicine treatment unit remained in treatment at 90 days. Longer retention was significantly associated with reduced opioid...

Impact of Policy Change on Access to Medication for Opioid Use Disorder in Primary Care

“…Interventions that connect PCPs with specialists, provide continuing education, and increase access to behavioral health providers have been shown to increase the number of waivered PCPs and MOUD access in primary care 31–35 . To address the lack of clinical capacity endorsed by some PCPs, interventions that expand telemedicine prescribing and establish MOUD comanagement with nurse care managers and pharmacists also have been successful 36–38 . Stigma, although a well-documented barrier to buprenorphine treatment in primary care in the past, 17 did not emerge as a prominent barrier in our study.…”

Buprenorphine Induction in a Rural Maryland Detention Center During COVID-19: Implementation and Preliminary Outcomes of a Novel Telemedicine Treatment Program for Incarcerated Individuals With Opioid Use Disorder

“…Our group has initiated several novel telemedicine-based buprenorphine programs since 2015, partnering with addiction behavioral treatment facilities and health departments in rural areas throughout the state of Maryland (22,33,34). The goal of these various programs is to fill an important addiction treatment gap in areas hard-hit by the opioid epidemic.…”

“…The outcomes from these various telemedicine-based buprenorphine programs are extremely encouraging and demonstrate a clinical benefit, with results comparable to those reported by direct (face-to-face) treatment. Chart reviews of buprenorphine-treated patients enrolled in our telemedicine-based buprenorphine programs demonstrate a 50-60% 3-month retention rate, with only 6-7 of those individuals testing positive for continues opioid use (22,33,34). The current initiative to provide treatment from within a detention center located in one of the areas where we have traction represents an important outgrowth of existing programs to reach at-risk incarcerated patients before they are released into the community.…”

“…Our Division of Addiction Research and Treatment within the Department of Psychiatry at the University of Maryland School of Medicine has been providing MOUD via telemedicine to a variety of substance use disorder treatment programs throughout the state of Maryland since 2015. With partnership programs across the state, the presence and variety of telemedicine models we provide is strongest in underserved rural counties in Maryland (21,22). The overlap of OUD and criminal justice involvement drove our team to look for ways in which to access vulnerable jail populations to provide OUD treatment prior to the risky period of discharge.…”

Buprenorphine treatment receipt characteristics and retention among people who inject drugs at Integrated Care Centers in India

“…Treatment drop-out was defined as not presenting to receive buprenorphine for 60 consecutive days without subsequent re-engagement in treatment for the duration of the study period. While there are no universally accepted definitions for treatment interruptions and treatment drop-out, we chose 60 days in alignment with previous studies among people receiving medications for opioid use disorders that have defined treatment interruptions and/ or treatment drop-out based on consecutive non-attendance for time periods anywhere between 30 and 90 days [18][19][20][21] . We additionally examined buprenorphine receipt frequency on average over the course of the first 6 months.…”