Telehealth Services Rendered During Pandemic Improved Opioid Use Disorder Care Retention

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CDC investigators stated that the expansion of telehealth strategies is “urgently needed” to provide medications for opioid use disorder because it could increase retention in care and improve outcomes for OUD.

In a recent study from the US Centers for Disease Control and Prevention (CD), investigators reviewed data from the US Centers for Medicare & Medicaid Services (CMS) to examine the receipt of telehealth services before and during the COVID-19 pandemic. The investigation focused on medications for opioid use disorder (OUD) including methadone, buprenorphine, and extended-release (ER) naltrexone.

In response to the pandemic, federal emergency authorities initiated the expansion of telehealth use for new and continued care, which included provision of medications for opioid use disorder. According to the findings, Medicare beneficiaries utilized telehealth for this purpose and had improved retention in care, as well as reduced odds of medically treated overdose.

Christopher M. Jones, PharmD, DrPH, National Center for Injury Prevention and Control, US Centers for Disease Control & Prevention and the team of investigators stated that based on the results, the expansion of these strategies is “urgently needed” to provide medications for opioid use disorder because it could increase retention in care and therefore, lead to overall better outcomes for the population.

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The Cohorts of Medicare Beneficiaries

The main outcomes and measures being assessed were the receipt and retention of medications for opioid use disorder, receipt of OUD and behavioral health-related telehealth services, and experiencing medically treated overdose. Study exposures consisted of pre-COVID-19 pandemic compared with COVID-19 pandemic cohort demographic characteristics, medical and substance use, and psychiatric comorbidities.

Investigators performed an exploratory longitudinal cohort study by examining CMS data from September 2018-February 2021. Included patients were Medicare fee-for-service beneficiaries 18 years and older and had clinical OUD diagnosis according to the International Statistical Classification of Diseases. Cohorts were distinguished as pre-pandemic (September 2018-February 2020) and during the pandemic (September 2019-February 2021).

The pre-pandemic cohort was comprised of 105,240 beneficiaries. The majority were between 45-74 years old (67.6%), female (58.1%), and non-Hispanic White (79.5%). The COVID-19 pandemic cohort had a total of 70,538 beneficiaries with similar demographics. This population was 57.1% female with 66.3% between the ages of 45-74 years, and 79.7% were non-Hispanic White.

Association of Telehealth and OUD Care Retention

Investigators found that a larger percentage of beneficiaries in the pandemic cohort received OUD-related telehealth services (19.6%) compared with the pre-pandemic cohort (0.6%). This trend was consistent with behavioral health-related telehealth services (41.0% vs 1.9%, respectively), and medication for opioid use disorder (12.6% vs.10.8%).

However, when comparing the percentage of patients who experienced a medically treated overdose, the results were similar, revealing 18.5% of those in the pre-pandemic cohort and 18.4% of those in the pandemic cohort utilizing rescue services.

Following analyses of the curated data, investigators observed an association between receipt of OUD-related telehealth services in the pandemic cohort and increased odds of medication for opioid use disorder retention. Additionally, this group had lowered odds of medically treated overdose.

Within this cohort, patients receiving medications for OUD from opioid treatment programs only as well as those receiving buprenorphine from pharmacies only demonstrated lower risk of medically treated overdose compared with patients who did not receive medications for OUD.

“Emergency authorities to expand use of telehealth and provide flexibilities for medications for OUD provision during the pandemic were used by Medicare beneficiaries initiating an episode of OUD-related care and were associated with improved retention in care and reduced odds of medically treated overdose,” investigators concluded. “Strategies to expand provision of medications for OUD and increase retention in care are urgently needed.”

The study, “Receipt of Telehealth Services, Receipt and Retention of Medications for Opioid Use Disorder, and Medically Treated Overdose Among Medicare Beneficiaries Before and During the COVID-19 Pandemic” was published in JAMA Psychiatry.