Telehealth Benefits for OUD Prompt Call for Permanent Adoption

Megan Brooks

September 02, 2022

A new study provides strong support for permanent adoption of expanded telehealth services and flexible prescribing of medications for opioid use disorder (OUD), experts say.

Results showed that expanded access to telehealth services, authorized during the COVID-19 pandemic, led to more Medicare beneficiaries with OUD entering treatment and staying in treatment, as well as to a decline in medically treated overdoses.

This is "really encouraging," lead author Christopher M. Jones, PharmD, acting director of the National Center for Injury Prevention and Control at the US Centers for Disease Control and Prevention (CDC), told Medscape Medical News.

"The findings add to the growing evidence base that pandemic-related changes to facilitate continuity of care for patients with OUD, such as authorities to expand telehealth services, were not only used by patients but also provided benefits to them — helping to build the case for permanent adoption of these flexibilities," said Jones.

The study was a collaborative effort led by researchers at the CDC, the National Institute on Drug Abuse, and the Centers for Medicare & Medicaid Services. It was published online August 31 in JAMA Psychiatry.

Increased Access, Use

The researchers analyzed data for 175,778 Medicare beneficiaries from September 2018 to February 2021.

They focused on receipt of telehealth services and medications for opioid use disorder (MOUD), as well as instances of medically treated overdoses among patients with OUD for whom a new episode of care was initiated either before or during the pandemic.

The prepandemic cohort included 105,240 beneficiaries, and the COVID-19 pandemic cohort had 70,538 beneficiaries. The two cohorts were similar with respect to gender, age, and race.

A larger percentage of the pandemic cohort received OUD-related telehealth services than did the prepandemic cohort (19.6% vs 0.6%; P < .001), as well as behavioral health-related telehealth services (41.0% vs 1.9%; P < .001) and MOUD (12.6% vs 10.8%; P < .001).

Receipt of OUD-related telehealth services by participants in the pandemic cohort was associated with significantly better retention in MOUD treatment (adjusted odds ratio [aOR], 1.27; 95% CI, 1.14 – 1.41) and lower odds of medically treated overdose (aOR, 0.67; 95% CI, 0.63 – 0.71).

In line with the broadening of telehealth access and use during the pandemic, about 1 in 8 beneficiaries in the pandemic cohort received OUD-related telehealth services at their initial OUD visit, compared with only 1 in 800 beneficiaries in the prepandemic period.

The percentage of beneficiaries who received OUD-related telehealth services was 35-fold higher in the pandemic than in the prepandemic cohort.

"Valuable" Evidence

"These findings support permanent adoption of expanded telehealth access and prescribing flexibilities," Mark Czeisler, PhD, Harvard Medical School, Boston, Massachusetts, and Turner Institute for Brain and Mental Health at Monash University, Melbourne, Australia, writes in an accompanying editorial.

The investigators have provided "valuable evidence of means to improve medication retention and reduce medically treated overdoses," he notes.

"Permanent expansion of telehealth services and medication dispensing flexibilities ― with widespread adoption of these measures ― would facilitate two effective strategies to combat the opioid epidemic," Czeisler writes.

While Jones agrees, he said, "Given the escalating overdose crisis, it is critical that efforts to expand telehealth services are pursued in tandem with efforts to expand equitable access to and provision of evidence-based treatment and improve retention in care and services."

The study was sponsored by the CDC, the Centers for Medicare & Medicaid Services, and the National Institutes of Health. Jones and Czeisler have reported no relevant financial relationships.

JAMA Psychiatry. Published online August 31, 2022. Abstract, Editorial

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