Telehealth services for opioid addiction reduced overdose deaths during COVID-19 pandemic

Key takeaways:

• Telehealth opioid use was linked to a 33% lower overdose death risk among Medicare beneficiaries during the pandemic compared with no treatment.
• The results emphasize the expansion of telehealth services.

Medicare beneficiaries using telehealth services for opioid use disorder during the COVID-19 pandemic had a 33% lower risk for fatal drug overdose compared with beneficiaries receiving no treatment, findings in JAMA Psychiatry showed.

“At a time when more than 100,000 Americans are now dying annually from a drug overdose, the need to expand equitable access to lifesaving treatment, including medications for opioid use disorder, has never been greater,” Wilson Compton, MD, MPE, deputy director of the National Institute on Drug Abuse, said in a press release. “Research continues to indicate that expanded access to telehealth is a safe, effective and possibly even lifesaving tool for caring for people with opioid use disorder, which may have a longer-term positive impact if continued.”

Defining a cohort

Compton and colleagues analyzed CMS Medicare Fee-for-Service data and the CDC’s National Death Index data to identify beneficiaries who received opioid use disorder-related treatment before or during the pandemic. For the pre-pandemic and pandemic cohorts, the researchers identified 6-month pre-index periods, which ranged from September 2018 to February 2019 and from September 2019 to February 2020, respectively. Beneficiaries who began treatment during these periods were excluded from their respective cohorts.

The researchers identified 105,162 beneficiaries who began OUD-related care from March 2019 to August 2019 — deemed the pre-pandemic cohort — and 70,479 beneficiaries who initiated care from March 2020 to August 2020 — deemed the pandemic cohort. Each cohort was followed until the February following treatment initiation.

Primary outcomes included receipt of telehealth services for OUD-related care, receipt of medication for OUD (MOUD) and drug overdose death.

Findings

Compared with the pre-pandemic cohort, beneficiaries in the pandemic cohort more often received telehealth OUD services (0.6% vs. 19.6%; P < .001) and more often received MOUD (10.8% vs. 12.6%; P < .001). Rates of all-cause mortality were greater during compared with before the pandemic (99.9 vs. 76.8 per 1,000 beneficiaries), as were rates of drug overdose death (5.1 vs. 3.7 per 1,000 beneficiaries).

However, the odds of drug overdose death were lower among receivers of telehealth services compared with beneficiaries receiving no MOUD (adjusted OR = 0.67; 95% CI, 0.48-0.92). The odds were also lower among beneficiaries receiving MOUD from opioid treatment programs (aOR = 0.41; 95% CI, 0.25-0.68) or buprenorphine in an office-based setting (aOR = 0.62; 95% CI, 0.43-0.91) compared with beneficiaries receiving no MOUD.

“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 disorder, as well as the need to improve retention and access to medication treatment for opioid use disorder,” Christopher M. Jones, PharmD, DrPH, lead author and director of the CDC National Center for Injury Prevention and Control, said in the release.

References:

• Increased use of telehealth services and medications for opioid use disorder during the COVID-19 pandemic associated with reduced risk for fatal overdose. https://www.cdc.gov/media/releases/2023/p0329-covid-opioids.html. Published March 29, 2023. Accessed April 3, 2023.
• Jones CM, et al. JAMA Psychiatry. 2023;doi:10.1001/jamapsychiatry.2023.0310.