Telehealth emerges as a promising avenue for enhancing access and long-term retention in the treatment of opioid use disorder, as indicated by a recent study analyzing Medicaid data from Kentucky and Ohio in 2019-2020. Published in JAMA Network Open, the study emphasizes that commencing buprenorphine treatment for opioid use disorder through telehealth is linked with a greater likelihood of extended treatment compared to non-telehealth settings, contributing to a growing body of evidence supporting the positive impact of telemedicine in opioid use disorder treatment.
In Kentucky, individuals initiating buprenorphine treatment via telehealth displayed a 48% retention rate in treatment for a continuous 90 days, surpassing the 44% rate among those starting treatment in non-telehealth settings. Similarly, in Ohio, the 90-day retention rate was 32% for telehealth-initiated treatment, compared to 28% for non-telehealth treatment.
This research was part of the HEALing Communities Study, supported by the National Institute on Drug Abuse (NIDA) in collaboration with the Substance Abuse and Mental Health Services Administration (SAMHSA) through the National Institutes of Health’s Helping to End Addiction Long-term Initiative (NIH HEAL Initiative).
The study’s findings underscore the potential of telehealth to enhance access and continuity of treatment, affirming its safety and benefits for those seeking addiction care. Dr. Nora Volkow, Director of NIDA, stresses the imperative of extending this accessible mode of care to address the unprecedented challenges posed by the overdose crisis.
Until 2020, individuals with opioid use disorder were mandated to have in-person meetings with healthcare providers to initiate buprenorphine treatment. However, with the onset of the COVID-19 pandemic, the U.S. government introduced prescribing flexibilities that allowed remote prescription of buprenorphine via telehealth without in-person assessments. This change expanded payment for telehealth services and diversified the communication technologies permissible for clinical care in substance use disorder cases via telehealth.
To assess the impact of these policy changes, researchers from the University of Kentucky analyzed Medicaid data from November 2019 to December 2020. Nearly 92,000 individuals had a buprenorphine prescription in 2020, and around 43,000 began treatment that year. The study highlighted substantial increases in telemedicine provision of buprenorphine following the pandemic-induced telehealth flexibilities.
Examining a subset of individuals who started treatment in the latter part of 2020, the study revealed a higher likelihood of continuing treatment for 90 continuous days for those commencing buprenorphine treatment via telehealth in both Kentucky and Ohio.
Furthermore, the study showed no increased likelihood of nonfatal overdose associated with receiving buprenorphine treatment via telehealth, indicating that increased access to telemedicine for this treatment did not harm patients.
Dr. Miriam E. Delphin-Rittmon, the HHS Assistant Secretary for Mental Health and Substance Use, highlighted telehealth as a pivotal tool for expanding access to life-saving medication, stressing the critical role it plays in reducing overdose deaths and aiding recovery.
However, the study noted disparities in treatment access and retention among certain groups, such as non-Hispanic Black individuals, men, and those with a history of prior opioid-related overdoses, who were less likely to receive or continue treatment through telehealth over the 90-day period.
The authors emphasized the necessity for further research beyond the Medicaid populations of Kentucky and Ohio and beyond the year 2020 to better understand the broader impact of telehealth on patient outcomes. Dr. Lindsey Hammerslag, the lead author and assistant professor at the University of Kentucky, highlighted the need to address barriers hindering equitable access to telehealth treatment, emphasizing the importance of these findings in shaping future policies and interventions.