Expansion of Telehealth, OUD Medication Access During Pandemic Raised Retention

Expansion of medications for opioid use disorder (MOUD) during the COVID-19 pandemic improved patient retention in care, according to findings published in JAMA Psychiatry.

Researchers from the US Centers for Disease Control and Prevention (CDC) and US Centers for Medicare and Medicaid Services conducted a retrospective cohort study using data from multiple Medicare and Medicaid Services databases. Trends in MOUD receipt and retention, telehealth use, and medically treated overdose rates were evaluated in 2 mutually exclusive cohorts of patients treated before the pandemic (September 2018 to February 2020; n=105,240) and during the pandemic (September 2019 to February 2021; n=70,538).

The pre-COVID-19 and COVID-19 cohorts comprised 58.1% (67.6% aged 45-74 years) and 57.1% (66.3% aged 45-74 years) women. Among the participants, 79.5% and 79.7% were White, respectively.

The rate of receiving MOUD at the baseline visit were low overall, but higher among the pandemic cohort (7.54%; P <.001) compared with the prepandemic cohort (4.43%; P <.001). At follow-up, the rate of MOUD receipt was 12.55% and 10.79% (P <.001) for the COVID-19 and pre-COVID-19 cohorts, respectively.

After receipt of MOUD, more patients treated with buprenorphine (33.26% vs 31.07%; P =.005) or in opioid treatment programs (50.93% vs 0.00%) during the pandemic had an adherence rate of at least 80% compared with the pre-COVID-19 group, respectively. No significant trends in naltrexone retention were observed.

During the pandemic, 68.6% of patients used telehealth services compared with 2.5% before the pandemic (P <.001). Baseline telehealth (12.1% vs 0.1%; P <.001), behavioral-related telehealth (41.0% vs 1.9%; P <.001), and opioid use disorder (OUD) telehealth (19.6% vs 0.6%; P <.001) rates were higher during the pandemic than prepandemic, respectively.

Medically attended overdose rates were similar during the pandemic (18.44%) as pre-pandemic (18.52%; P =.65).

High retention in MOUD during the pandemic was associated with participants who received OUD-related telehealth (adjusted odds ratio [aOR], 1.267), were aged 45 to 64 years compared with those aged 18 to 44 years (aOR, 1.226), and who had obesity (aOR, 1.125).

Retention was negatively related with the following:

• Time spent in a nursing home (aOR range, 0.024-0.583);
• Stimulant use disorder (aOR, 0.546);
• Cocaine use disorder (aOR, 0.560);
• Black ethnicity (aOR, 0.699);
• Cancer (aOR, 0.709);
• Personality disorder (aOR, 0.717);
• Alcohol use disorder (aOR, 0.745);
• Cannabis use disorder (aOR, 0.753);
• Schizophrenia or other psychotic disorder (aOR, 0.782);
• Liver disease (aOR, 0.829);
• Acute or chronic pain (aOR, 0.838);
• Chronic respiratory disease (aOR, 0.872); and
• Cardiovascular or other circulatory conditions (aOR, 0.888).

Experiencing a medically attended overdose in the pandemic was less likely among patients who received OUD-related telehealth services (aOR, 0.671).

As with other database studies, distribution of medications was a proxy for medication use.

Study authors concluded, “Authorities to facilitate use of telehealth and provision of MOUD during the COVID-19 pandemic were used by Medicare beneficiaries initiating new episodes of OUD-related care. Use of telehealth during the pandemic was associated with improved retention in care and reduced odds of medically treated overdose, providing support for permanent adoption.”

Disclosure: An author declared affiliations with industry. Please refer to the original article for a full list of disclosures.