Telehealth services for opioid use disorder during pandemic decreased risk for overdose
Telehealth services used by Medicare beneficiaries who initiated opioid use disorder-related care during the COVID-19 pandemic were associated with improved retention in care and reduced odds for overdose.
“COVID-19 pandemic–related stressors and implementation of mitigation measures, such as stay-at-home orders, raised concerns about increasing overdose risk among individuals with [opioid use disorders] and disruptions to [medications for opioid use disorders] and other treatment and recovery support services,” Christopher M. Jones, PharmD, DrPH, MPH, of the CDC’s National Center for Injury Prevention and Control, and colleagues wrote in JAMA Psychiatry.
The researchers conducted an exploratory longitudinal cohort study, using Medicare and Medicaid services from September 2018 to February 2021, to examine telehealth services, medications for opioid use disorder receipt and retention, as well as overdose rates before and after the pandemic.
The authors established two cohorts: one before the pandemic from September 2018 to February 2020; and one during the pandemic from September 2019 to February 2021. All participants were aged 18 years or older, Medicare fee-for-service beneficiaries and had an opioid use disorder diagnosis.
The pre-pandemic cohort comprised 105,240 individuals (58.1% female; 67.6% aged 45 to 74 years); the pandemic cohort included 70,538 participants (57.1% female; 66.3% aged 45 to 74 years).
Compared with the pre-pandemic cohort, more participants in the pandemic cohort received opioid use disorder-related telehealth service (19.6% vs. 0.6%), behavioral health services (41% vs. 1.9%) and medications for opioid use disorders (12.6% vs. 10.8%).
The percentage of participants who experienced a medically treated overdose was similar between the two groups — 18.5% in the pre-pandemic, compared with 18.4% in the pandemic cohort.
According to the authors, receipt of opioid use disorder-related telehealth services during the pandemic was linked to increased odds of medications for opioid use disorder retention (adjusted OR, 1.27; 95% CI, 1.14-1.41), as well as lower odds of medically treated overdose (aOR, 0.67; 95% CI, 0.63-0.71).
Specifically, those in the pandemic cohort who received medications for opioid use disorders from opioid treatment programs only (aOR, 0.54; 95% CI, 0.47-0.63) and those who received buprenorphine from pharmacies only (aOR, 0.91; 95% CI, 0.84-0.98) had lower odds of medically treated overdose compared with those who did not receive medications for opioid use disorder.
“Strategies to increase access to care and [medications for opioid use disorders] receipt and retention are urgently needed, and the results of this study add to the growing research documenting the benefits of expanding the use of telehealth services for people with [opioid use disorders],” Jones said in a related NIH press release. “The findings from this collaborative study also highlight the importance of working across agencies to identify successful approaches to address the escalating overdose crisis.”
In a related JAMA Psychiatry editorial, Mark E. Czeisler, PhD, of Harvard Medical School, wrote that although telehealth services were initially offered as a way to mitigate the spread of COVID-19, the benefits of telehealth expand beyond that.
“Many advantages of telehealth and take-home medications have pre-pandemic precedence and should have been considered even in the absence of a pandemic,” Czeisler wrote. “The accelerating opioid epidemic should inspire swift action designed to equitably increase engagement with evidence-based strategies to address opioid misuse and, in turn, save lives.”
References:
Czeisler ME, et al. JAMA Psychiatry. 2022;doi:10.1001/jamanetworkopen.2022.2032.
Increased use of telehealth for OUD services during COVID-19 pandemic associated with reduced risk of overdose. https://nida.nih.gov/news-events/news-releases/2022/08/increased-use-of-telehealth-for-opioid-use-disorder-services-during-covid-19-pandemic-associated-with-reduced-risk-of-overdose. Published Aug. 31, 2022; Accessed Aug. 31, 2022.