A new study featured in the JAMA Network Open has revealed that there is no significant difference in clinical outcomes among opioid use disorder (OUD) patients regardless of whether they are receiving treatment from clinicians with high or low telehealth use.
The COVID-19 pandemic has resulted in an unprecedented shift in the way opioid use disorder treatment is delivered, with a move towards increased use of telemedicine. This new approach has been proposed as a potential solution to reduce barriers to OUD treatment, with preliminary research suggesting that telemedicine may lead to increased access to buprenorphine and higher rates of MOUD initiation. This new study was conducted in order to examine clinical telemedicine use during the pandemic and its associted differences in care for OUD.
For this study, researchers looked at claims for telemedicine visits over two separate periods: March 14, 2019, to March 13, 2020, and March 14, 2020, to March 13, 2021. The criteria for inclusion in the study as a patient included having opioid use disorder (OUD) and being enrolled in a commercial insurance or Medicare Advantage plan. Clinicians included in the study provided office-based OUD treatment and were divided into low, medium, or high telehealth-use groups. The study population consisted of 11,801 patients who received treatment from 1,768 clinicians, with a mean age of 53.9, and 5,902 of them were male. The outcomes assessed were all outpatient visits, the type of OUD visit within 90 days of an index visit, the prescribing of medications for OUD (MOUD), and clinical events related to OUD, such as drug overdose or rehabilitation center stay.
The researchers determined that despite an increase in the use of telehealth for opioid use disorder (OUD) between the pre-pandemic and mid-pandemic periods, the overall visit volume for OUD episodes per patient remained consistent among clinicians who had either high or low telehealth use rates. Additionally, there were no discernable alterations in the initiation of medication for opioid use disorder (MOUD), number of days’ supply of MOUD, or opioid-related clinical events among all participants.
The researchers determined that the results showed that care patterns and outcomes of these patients were comparable whether they were treated by clinicians who primarily used telemedicine or those who provided in-person care. Additionally, they stated that there was no evidence to suggest that telemedicine was used excessively by clinicians with high versus low telemedicine use, or that its adoption was linked to greater access or improved quality of care. The researchers concluded “taken together, these findings suggest that telemedicine is an acceptable alternative for OUD treatment, but is unlikely to significantly alter care quality or access in the short term.”
The study did note some limitations, however, such as its observational nature, meaning that associations were reported rather than causal links. Furthermore, the findings may not be applicable to other populations, and the outcomes only capture a part of the access to care process. Additionally, the researchers were unable to measure long-acting buprenorphine implants or other important clinical outcomes such as OUD relapse or patient functioning, and the rates of overdose were restricted to those who initiated OUD treatment.
