Telehealth Increases Buprenorphine Treatment Retention Among Veterans

Reducing access to buprenorphine telehealth services may disrupt treatment among many patients receiving buprenorphine for opioid use disorder (OUD), according to study findings published in JAMA Network Open.

Researchers sourced data from the Veterans Health Administration Corporate Data Warehouse. Veterans (N=17,182) with OUD who filled at least 1 buprenorphine prescription between March 2020 and 2021 were evaluated for treatment retention on the basis of when they initiated treatment (ie, prior to or after COVID-19 changes) and treatment modality (ie, video visits, telephone visits, or in-person visits).

The study population comprised 92.2% men, 82.0% of whom were White, 41.3% were aged 30 to 44 years, and 36.4% were aged 45 to 64 years.

Use of any telehealth service was associated with those aged 65 years and older (adjusted odds ratio [aOR], 1.94; 95% CI, 1.40-2.68), those aged 45 to 64 years (aOR, 1.77; 95% CI, 1.31-2.39), and 30 to 44 years (aOR, 1.45; 95% CI, 1.08-1.95) compared with participants aged 18 to 29 years; 50%-100% service connection compared with nonservice VA eligibility (aOR, 1.24; 95% CI, 1.09-1.41); alcohol use disorder (aOR, 0.84; 95% CI, 0.74-0.95); serious mental illness (aOR, 0.81; 95% CI, 0.71-0.92); male sex (aOR, 0.74; 95% CI, 0.61-0.91); Black (aOR, 0.71; 95% CI, 0.61-0.84) or unknown (aOR, 0.77; 95% CI, 0.62-0.97) ethnicity compared with White ethnicity; stimulant use disorder (aOR, 0.64; 95% CI, 0.57-0.72); and other substance use disorder (aOR, 0.68; 95% CI, 0.60-0.77).

Use of any video telehealth compared with only telephone visits was associated with 50%-100% (aOR, 1.28; 95% CI, 1.16-1.40) and less than 50% service connection (aOR, 1.13; 95% CI, 1.02-1.26) compared with nonservice VA eligibility, homelessness, or housing instability (aOR, 0.81; 95% CI, 0.73-0.89), male sex (aOR, 0.81; 95% CI, 0.71-0.92), Black ethnicity compared with White ethnicity (aOR, 0.73; 95% CI, 0.64-0.83), and age of 65 years and older compared with ages 18 to 29 years (aOR, 0.53; 95% CI, 0.41-0.70).

Among the 4338 patients who initiated treatment following COVID-19 changes, 32.2% of patients who used telehealth were retained in treatment for at least 90 days compared with 25.4% of patients who used only in-person visits (P <.001). Among the telehealth group, the retention rate was higher for individuals who used at least 1 video visit compared with those who used only telephone visits (37.2% vs 27.7%; P <.001), respectively. Similarly, among the patients who initiated treatment prior to COVID-19 (n=12,844), telehealth was associated with a higher retention rate than in-person visits (51.1% vs 43.0%; P <.001), respectively.

Any telehealth use was associated with 90-day retention for those who initiated treatment after (aOR, 1.31; 95% CI, 1.12-1.53) and before (aOR, 1.23; 95% CI, 1.08-1.39) COVID-19 changes, and any video visit was associated with retention after COVID-19 changes (aOR, 1.47; 95% CI, 1.26-1.71).

This study was designed to be exploratory and significant relationships should not be interpreted as causal.

Study authors conclude, “Telehealth receipt was associated with 90-day retention regardless of when patients had initiated buprenorphine relative to the implementation of COVID-19–related policies. […] Policy makers and clinical leaders should carefully consider the potential impacts of forthcoming decisions related to buprenorphine telehealth policies. Discontinuation or reduction of telehealth availability may disrupt treatment for many patients, and discontinuation or reduction of telephone-only access may have an outsized effect on groups who have historically faced disparities in buprenorphine access.”

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