Understanding opportunities and challenges with telemedicine-delivered buprenorphine during the COVID-19 pandemic

Mattocks, Kristin M.; Moore, David T; Wischik, Dora Lendvai; Lazar, Christina M.; Rosen, Marc I.

doi:10.1016/j.jsat.2022.108777

Cited by 21 publications

(22 citation statements)

References 40 publications

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“…Studies should also examine the association of modality with other elements of treatment quality, including adverse outcomes such as overdose events. The practices of individual clinicians will impact whether patients are offered buprenorphine telehealth (regardless of policies allowing these modalities), and several recent studies examining clinicians’ experiences have found variability in their comfort and interest in continuing to offer telehealth . Additional studies with clinicians providing buprenorphine beyond the COVID-19 context are needed to identify and address barriers to continuing telehealth.…”

Section: Discussionmentioning

confidence: 99%

“…The practices of individual clinicians willJAMA Network Open | Substance Use and AddictionVideo, Telephone, and In-Person Buprenorphine Treatment for OUD During the COVID-19 Pandemic impact whether patients are offered buprenorphine telehealth (regardless of policies allowing these modalities), and several recent studies examining clinicians' experiences have found variability in their comfort and interest in continuing to offer telehealth. [49][50][51][52][53] Additional studies with clinicians providing buprenorphine beyond the COVID-19 context are needed to identify and address barriers to continuing telehealth. Research should also continue to examine patient experiences and preferences related to buprenorphine treatment modality [54][55][56].…”

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confidence: 99%

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Use of and Retention on Video, Telephone, and In-Person Buprenorphine Treatment for Opioid Use Disorder During the COVID-19 Pandemic

et al. 2022

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ImportanceThe coronavirus disease 2019 (COVID-19) pandemic prompted policy changes to allow increased telehealth delivery of buprenorphine, a potentially lifesaving medication for opioid use disorder (OUD). It is unclear how characteristics of patients who access different treatment modalities (in-person vs telehealth, video vs telephone) vary, and whether modality is associated with retention—a key indicator of care quality.ObjectivesTo compare patient characteristics across receipt of different treatment modalities and to assess whether modality was associated with retention during the year following COVID-19–related policy changes.Design, Setting, and ParticipantsThis cross-sectional study was conducted in the national Veterans Health Administration. Participants included patients who received buprenorphine for OUD during March 23, 2020, to March 22, 2021. Analyses examining retention were stratified by buprenorphine initiation time (year following COVID-19–related changes; prior to COVID-19–related changes).ExposuresPatient characteristics; treatment modality (at least 1 video visit, at least 1 telephone visit but no video, only in-person).Main Outcomes and MeasuresTreatment modality; 90-day retention.ResultsAmong 17 182 patients, 7094 (41.3%) were aged 30 to 44 years and 6251 (36.4%) were aged 45 to 64 years; 15 835 (92.2%) were male, 14 085 (82.0%) were White, and 16 292 (94.8%) were non-Hispanic; 6547 (38.1%) had at least 1 video visit, 8524 (49.6%) had at least 1 telephone visit but no video visit, and 2111 (12.3%) had only in-person visits. Patients who were younger, male, Black, unknown race, Hispanic, non–service connected, or had specific mental health/substance use comorbidities were less likely to receive any telehealth. Among patients who received telehealth, those who were older, male, Black, non–service connected, or experiencing homelessness and/or housing instability were less likely to have video visits. Retention was significantly higher for patients with telehealth compared with only in-person visits regardless of initiation time (for initiated in year following COVID-19–related changes: adjusted odds ratio [aOR], 1.31; 95% CI, 1.12-1.53; for initiated prior to COVID-19–related changes: aOR, 1.23; 95% CI, 1.08-1.39). Among patients with telehealth, higher retention was observed in those with video visits compared with only telephone for patients who initiated in the year following COVID-19 (aOR, 1.47; 95% CI, 1.26-1.71).Conclusions and RelevanceIn this cross-sectional study, many patients accessed buprenorphine via telephone and some were less likely to have any video visits. These findings suggest that discontinuing or reducing telephone access may disrupt treatment for many patients, particularly groups with access disparities such as Black patients and those experiencing homelessness. Telehealth was associated with increased retention for both new and continuing patients.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Use of and Retention on Video, Telephone, and In-Person Buprenorphine Treatment for Opioid Use Disorder During the COVID-19 Pandemic

et al. 2022

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“…Some service adaptations, such as home delivery of OAT, sought to reduce stigma and redress the power imbalance in the patient-provider relationship. The reduced monitoring during the pandemic period implied more trust in the ability of people receiving OAT to make autonomous decisions and improved their experience of care, as seen in studies in the USA ( Mattocks et al, 2022 , Hoffman et al, 2022 ). The pandemic presented an opportunity to open a dialogue on the needs of the person receiving OAT, to ensure people were receiving appropriate care and were informed about the existence of pathways for meaningful participation in their own treatment ( Bryant et al, 2008 , Marchand et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

“You'll come in and dose even in a global pandemic”: A qualitative study of adaptive opioid agonist treatment provision during the COVID-19 pandemic

Conway¹,

Treloar²,

Crawford³

et al. 2023

International Journal of Drug Policy

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“…While prescribers generally supported telehealth practices, many noted challenges or drawbacks, and some preferred telehealth not replace in-person care for an extended period. 31 Noted challenges included inability to rely on clinical tests to monitor treatment adherence, 58 patient distractions while on video, 58 inadequate technology among patients or clinics, 51 and issues with pharmacy dispensing following telehealth visits. 55 Some felt uncomfortable caring for new patients via video visits, 26 or had difficulty adapting to the reliance on technology, reduced communication across care teams, and potential for increased liability.…”

Section: Prescriber Challenges With Telehealthmentioning

confidence: 99%

“…51 Some mentioned difficulty balancing patient preferences with clinician perceptions of patient "stability" 50 and shifting from "paternalistic" standards of care such as frequent drug screens. 58 Some of these preferences were associated with provider characteristics. For example, in one study, prescribers working in an OTP were less likely than prescribers working in other settings to prefer telehealth visits.…”

Section: Prescriber Challenges With Telehealthmentioning

confidence: 99%

Pandemic telehealth flexibilities for buprenorphine treatment: A synthesis of evidence and policy implications for expanding opioid use disorder care in the U.S

Krawczyk¹,

Rivera²,

King³

et al. 2023

Preprint

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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 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.

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Understanding opportunities and challenges with telemedicine-delivered buprenorphine during the COVID-19 pandemic

Cited by 21 publications

References 40 publications

Use of and Retention on Video, Telephone, and In-Person Buprenorphine Treatment for Opioid Use Disorder During the COVID-19 Pandemic

Use of and Retention on Video, Telephone, and In-Person Buprenorphine Treatment for Opioid Use Disorder During the COVID-19 Pandemic

“You'll come in and dose even in a global pandemic”: A qualitative study of adaptive opioid agonist treatment provision during the COVID-19 pandemic

Pandemic telehealth flexibilities for buprenorphine treatment: A synthesis of evidence and policy implications for expanding opioid use disorder care in the U.S

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