Expanded telehealth helped patients treated for opioid use disorder in COVID-19 pandemic

Practices could continue to help, but experts say there are still challenges to overcome.

Expanding telehealth services for opioid use disorder (OUD) can help keep patients in treatment longer and reduce risks of overdosing.

The findings were part of a new study that compared telehealth usage for 105,240 OUD patients before the COVID-19 pandemic and for 70,538 who began treatment during the pandemic. At that time, federal regulators supported broader use of telehealth services and relaxed policies on prescribing methadone and buprenorphine for OUD treatment, said the study published Aug. 31 in JAMA Psychiatry.

Those changes “were associated with improved MOUD retention and lower odds of medically treated overdose, lending support for permanent adoption,” said the study, which used data from the U.S. Centers for Medicare & Medicaid Services from September 2018 to February 2021.

Expanded telehealth and medications for opioid use disorder (MOUD) could save lives, countering an overdose death rate that set a record in 2021 and is projected to get worse, not better, in the next few years.

“The expansion of telehealth services for people with substance use disorders during the pandemic has helped to address barriers to accessing medical care for addiction throughout the country that have long existed,” senior author Wilson Compton, MD, MPE, deputy director of the National Institute on Drug Abuse, said in a news release. “Telehealth is a valuable service and when coupled with medications for opioid use disorder can be lifesaving. This study adds to the evidence showing that expanded access to these services could have a longer-term positive impact if continued.”

The findings

The study compared the COVID-19 cohort and the pre-pandemic cohort and found the former used telehealth more for any health service (68.6% vs 2.5%), for behavorial health (41% vs. 1.9%), and for OUD treatment (19.6% vs. 0.6%). Proportionally, the COVID-19 cohort were more likely to receive MOUD (12.6% vs. 10.8%).

Both groups had similar rates of medically treated overdose, although patients receiving OUD telehealth services had lower odds of overdose when figures were adjusted for MOUD, demographic background, and clinical characteristics, the study said.

Both groups had “only a small proportion of individuals” who received MOUD on 80% or more of eligible days. “This finding underscores the ongoing challenges in engaging and retaining patients in treatment,” the study said.

The national figures also showed health inequities consistent with previous research showing less access and less provision of MOUD for racial and ethnic minorities, the study said

New approaches

The study authors were clear more research is needed on telehealth and OUD, which affirmed expert discussion convened by the National Academy of Medicine (NAM) in December 2021. This summer, NAM published those discussion proceedings in “Introduction to Improving Telehealth and Virtual Care for Pain Management and Opioid/Substance Use Disorder.”

Daniel P. Alford, MD, MPH, explained the COVID-19 pandemic telehealth had positive effects:

  • Increased access to and convenience of care.
  • Reduced anxiety for patients.
  • Improved understanding patients’ home environments, which can improve therapeutic relationships.

But telehealth has reduced the structure and accountability for patients, lessened information for clinical decision making, and added difficulty in establishing personal connections with patients. There are also technology-related challenges and limitations, Alford said.

The NAM panelists agreed the time is now to redesign models of care that incorporate telehealth when appropriate, not “simply replicating current practices in a virtual environment,” the discussion proceedings said.