Pandemic telehealth flexibilities for buprenorphine treatment: a synthesis of evidence and policy implications for expanding opioid use disorder care in the United States

Abstract

Buprenorphine is a highly effective treatment for opioid use disorder and a critical tool for addressing the worsening U.S. overdose crisis. However, multiple barriers to treatment - including stringent federal regulations - have historically made this medication hard to reach for many who need it. In 2020, under the COVID-19 Public Health Emergency, federal regulators substantially changed access to buprenorphine by allowing prescribers to initiate patients on buprenorphine via telehealth without first evaluating them in person. As the Public Health Emergency is set to expire in May of 2023, Congress and federal agencies can leverage extensive evidence from studies conducted during the wake of the pandemic to make evidence-based decisions on the regulation of buprenorphine going forward. To aid policy makers, this narrative review synthesizes and interprets peer-reviewed research on the effect of buprenorphine flexibilities on uptake and implementation of telehealth, and its impact on OUD patient and prescriber experiences, access to treatment and health outcomes. Overall, our review finds that many prescribers and patients took advantage of telehealth, including the audio-only option, with a wide range of benefits and few downsides. As a result, federal regulators—including agencies and Congress—should continue non-restricted use of telehealth for buprenorphine initiation.

Patient and Clinician Experiences with the Implementation of Telemedicine and Related Adaptations in Office-Based Buprenorphine Treatment During the COVID-19 Pandemic: A Qualitative Study

“…Our findings from the patient perspective also align with previous studies, which have found patients appreciated having options and the flexibility telemedicine provided in the context of competing demands and priorities in their lives [ 16 ]. However, though telemedicine may offer distinct benefits, particularly in helping patients overcome barriers to appointment attendance, a notable finding in this study was that patients’ views on the appropriateness of telemedicine visits centered around an individual’s stage of recovery, with the perceived need for structure and accountability early in treatment as a key concern.…”

“…Overall, our results support telemedicine as an acceptable method for providing office-based buprenorphine treatment for individuals with OUD and demonstrate how it can improve access to and retention in care for many patients. These findings align with those from prior studies indicating that the COVID-19-related regulatory flexibilities around the use of telemedicine for office-based buprenorphine treatment should be maintained [ 16 , 20 ]. In addition, patients in this study–the majority of whom were publicly-insured–expressed a desire to have a combination of telemedicine and in-person visits moving forward.…”

“…Our findings from the clinician perspective align with prior work in which clinicians felt telemedicine had benefits such as increased access and convenience for patients [ 16 ]. Clinicians in this study felt there was a role for telemedicine in their practice moving forward, particularly to improve patients’ engagement and retention in treatment.…”

“…Prior studies with clinicians engaged in office-based buprenorphine treatment have found telemedicine may help reduce barriers to treatment initiation and ongoing engagement in care, but also identified challenges including the potential loss of information gained through clinical and physical assessments, and patients’ limited technology access, particularly for video encounters [ 16 – 20 ]. Research with patients has indicated that telemedicine provided increased flexibility and autonomy, but also highlighted difficulties accessing medications and raised questions surrounding how telemedicine could differentially impact structurally marginalized populations [ 16 , 21 – 27 ].…”

Transitions of care between jail-based medications for opioid use disorder and ongoing treatment in the community: A retrospective cohort study

“…Continued efforts to increase COVID-19 flexibilities for methadone take-homes and facilitating the initiation of buprenorphine via telehealth, which has been found to facilitate initiation and retention in MOUD, are strategies that can help facilitate long-term outcomes in these treatments. 65,66 Expanding methadone to other treatment settings, including mobile health vans (which have recently launched in NY) 67,68 and office-based practices as is done in many non-US settings, 69 and which has been proposed by recent legislation, may also improve MMT access and continuity. Importantly, ensuring connections to harm reduction programs is also critical for ensuring reduced overdose among this population.…”