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

Frost, Madeline C.; Zhang, Lan; Kim, H. Myra; Lin, Lewei Allison

doi:10.1001/jamanetworkopen.2022.36298

Cited by 48 publications

(56 citation statements)

References 53 publications

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“…Notably, these policy changes substantially lowered the barriers for patients to receive MOUD and have thus far not been shown to have negatively impacted patient outcomes, including mortality. 19 , 28 – 31 …”

Section: Discussionmentioning

confidence: 99%

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Access to Medications for Opioid Use Disorder in Rural Versus Urban Veterans Health Administration Facilities

et al. 2023

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Background For patients with opioid use disorder (OUD), medications for OUD (MOUD) reduce morbidity, mortality, and return to use. Nevertheless, a minority of patients receive MOUD, and underutilization is pronounced among rural patients. Objective While Veterans Health Administration (VHA) initiatives have improved MOUD access overall, it is unknown whether access has improved in rural VA health systems specifically. How “Community Care,” healthcare paid for by VHA but received from non-VA providers, has affected rural access is also unknown. Design Data for this observational study were drawn from the VHA Corporate Data Warehouse. Facility rurality was defined by rural-urban commuting area code of the primary medical center. International Classification of Diseases codes identified patients with OUD within each year, 2015–2020. We included MOUD (buprenorphine, methadone, extended-release naltrexone) received from VHA or paid for by VHA but received at non-VA facilities through Community Care. We calculated average yearly MOUD receipt; linear regression of outcomes on study years identified trends; an interaction between year and rural status evaluated trend differences over time. Participants All 129 VHA Health Systems, a designation that encompasses one or more medical centers and their affiliated community-based outpatient clinics Main Measures The average proportion of patients diagnosed with OUD that receive MOUD within rural versus urban VHA health care systems. Key Results From 2015 to 2020, MOUD access increased substantially: the average proportion of patients receiving MOUD increased from 34.6 to 48.9%, with a similar proportion of patients treated with MOUD in rural and urban systems in all years. Overall, a small proportion (1.8%) of MOUD was provided via Community Care, and Community Care did not disproportionately benefit rural health systems. Conclusions Strategies utilized by VHA could inform other health care systems seeking to ensure that, regardless of geographic location, all patients are able to access MOUD. Supplementary Information The online version contains supplementary material available at 10.1007/s11606-023-08027-4.

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Section: Discussionmentioning

confidence: 99%

“… 7 Recent national efforts have included the Stepped Care for Opioid Use Disorder Train the Trainer Initiative, increased buprenorphine prescribing through telemedicine, external facilitation provided to low-performing sites, and an initiative to hire clinical pharmacists to address substance use disorders in rural settings. 13 – 19 …”

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confidence: 99%

Access to Medications for Opioid Use Disorder in Rural Versus Urban Veterans Health Administration Facilities

et al. 2023

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“…37 Finally, one study, among a sample of VHA patients who initiated buprenorphine following COVID-19-related regulatory changes, found higher odds of retention among those who had telehealth visits compared to those who had only in-person visits (odds ratio (OR) 1.31; 95% CI, 1.12-1.53). 36 However, among those who received telehealth, odds of retention was higher among patients who had video visits than only telephone visits (OR: 1.47; 95% CI, 1.26-1.71). 36…”

Section: Telehealth Impact On Buprenorphine Retentionmentioning

confidence: 96%

“…36 However, among those who received telehealth, odds of retention was higher among patients who had video visits than only telephone visits (OR: 1.47; 95% CI, 1.26-1.71). 36…”

Section: Telehealth Impact On Buprenorphine Retentionmentioning

confidence: 96%

“…Multiple studies found that telehealth successfully engaged buprenorphine patients with various health and socioeconomic challenges. This included veterans, 36 individuals experiencing homelessness, 38,39 individuals with co-occurring psychiatric needs, 38 individuals with criminal justice involvement, 38 individuals from rural areas, 41 individuals who inject drugs, 42 and individuals from minoritized racial/ethnic groups. 38 Multiple studies analyzed patient data from 'low-threshold' buprenorphine treatment programs, which aim to eliminate as many barriers as possible to accessing care.…”

Section: Feasibility Of Telehealth Buprenorphinementioning

confidence: 99%

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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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Trends in Use of Medication to Treat Opioid Use Disorder During the COVID-19 Pandemic in 10 State Medicaid Programs

et al. 2023

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ImportanceFederal and state agencies granted temporary regulatory waivers to prevent disruptions in access to medication for opioid use disorder (MOUD) during the COVID-19 pandemic, including expanding access to telehealth for MOUD. Little is known about changes in MOUD receipt and initiation among Medicaid enrollees during the pandemic.ObjectivesTo examine changes in receipt of any MOUD, initiation of MOUD (in-person vs telehealth), and the proportion of days covered (PDC) with MOUD after initiation from before to after declaration of the COVID-19 public health emergency (PHE).Design, Setting, and ParticipantsThis serial cross-sectional study included Medicaid enrollees aged 18 to 64 years in 10 states from May 2019 through December 2020. Analyses were conducted from January through March 2022.ExposuresTen months before the COVID-19 PHE (May 2019 through February 2020) vs 10 months after the PHE was declared (March through December 2020).Main Outcomes and MeasuresPrimary outcomes included receipt of any MOUD and outpatient initiation of MOUD via prescriptions and office- or facility-based administrations. Secondary outcomes included in-person vs telehealth MOUD initiation and PDC with MOUD after initiation.ResultsAmong a total of 8 167 497 Medicaid enrollees before the PHE and 8 181 144 after the PHE, 58.6% were female in both periods and most enrollees were aged 21 to 34 years (40.1% before the PHE; 40.7% after the PHE). Monthly rates of MOUD initiation, representing 7% to 10% of all MOUD receipt, decreased immediately after the PHE primarily due to reductions in in-person initiations (from 231.3 per 100 000 enrollees in March 2020 to 171.8 per 100 000 enrollees in April 2020) that were partially offset by increases in telehealth initiations (from 5.6 per 100 000 enrollees in March 2020 to 21.1 per 100 000 enrollees in April 2020). Mean monthly PDC with MOUD in the 90 days after initiation decreased after the PHE (from 64.5% in March 2020 to 59.5% in September 2020). In adjusted analyses, there was no immediate change (odds ratio [OR], 1.01; 95% CI, 1.00-1.01) or change in the trend (OR, 1.00; 95% CI, 1.00-1.01) in the likelihood of receipt of any MOUD after the PHE compared with before the PHE. There was an immediate decrease in the likelihood of outpatient MOUD initiation (OR, 0.90; 95% CI, 0.85-0.96) and no change in the trend in the likelihood of outpatient MOUD initiation (OR, 0.99; 95% CI, 0.98-1.00) after the PHE compared with before the PHE.Conclusions and RelevanceIn this cross-sectional study of Medicaid enrollees, the likelihood of receipt of any MOUD was stable from May 2019 through December 2020 despite concerns about potential COVID-19 pandemic–related disruptions in care. However, immediately after the PHE was declared, there was a reduction in overall MOUD initiations, including a reduction in in-person MOUD initiations that was only partially offset by increased use of telehealth.

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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

Cited by 48 publications

References 53 publications

Access to Medications for Opioid Use Disorder in Rural Versus Urban Veterans Health Administration Facilities

Access to Medications for Opioid Use Disorder in Rural Versus Urban Veterans Health Administration Facilities

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

Trends in Use of Medication to Treat Opioid Use Disorder During the COVID-19 Pandemic in 10 State Medicaid Programs

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