Telehealth Linked to Better Opioid Treatment Retention

TOPLINE:

Starting treatment with buprenorphine for opioid use disorder (OUD) via telehealth is associated with longer retention in treatment compared with starting treatment in-person, new research suggests.

METHODOLOGY:

• Researchers analyzed Medicaid claims data from November 2019 through the end of 2020 in Kentucky and Ohio to investigate the impact of a policy change implemented during the COVID-19 pandemic that allowed the use of telehealth to prescribe buprenorphine for OUD.

• The two main outcomes of interest were retention in treatment after initiation (telehealth vs traditional) and opioid-related nonfatal overdose after initiation.

TAKEAWAY:

• For both states combined, nearly 92,000 adults had a buprenorphine prescription in at least one quarter in 2020, with nearly 43,000 of those individuals starting treatment in 2020. 

• Sharp increases in telehealth delivery of buprenorphine were noted at the beginning of 2020 at the pandemic outset, and this was associated with greater retention in treatment (Kentucky adjusted odds ratio [aOR], 1.13; 95% CI, 1.01 – 1.27 and Ohio aOR, 1.19; 95% CI, 1.06 – 1.32).

• 90-day retention rates were higher among those who started treatment via telehealth vs those who started treatment in non-telehealth settings in Kentucky (48% vs 44%, respectively) and in Ohio (32% vs 28%, respectively).

• There was no increased risk of nonfatal overdose with telehealth treatment, providing added evidence to suggest that patients were not harmed by having increased access to buprenorphine treatment via telehealth.

IN PRACTICE:

“These results offer important insights for states with a high burden of OUD looking to policies and methods to reduce barriers to treatment,” the authors write.

SOURCE:

The study, with first author Lindsey Hammerslag, PhD, with University of Kentucky College of Medicine, Lexington, was published online October 18 in JAMA Network Open, with an invited commentary by Lindsey Allen, PhD, Northwestern University, Chicago, on navigating the path to effective, equitable, and evidence-based telehealth for OUD treatment.

LIMITATIONS:

The analysis was limited to Medicaid patients in two states over 1 year and there may have been unmeasured confounders, such as perceived patient stability, that influenced the findings. Because Medicaid data were not linked to emergency services or death records, this study considered only medically treated overdose.

DISCLOSURES:

The study was supported by the National Institute on Drug Abuse and carried out in partnership with the Substance Abuse and Mental Health Services Administration. The authors report no relevant financial relationships.

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