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Study: Pandemic telehealth use linked to lower opioid overdose risk

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Receiving opioid use disorder-related telehealth care during the COVID-19 pandemic was associated with lower odds of medically treated overdose and better retention using medications like methadone and buprenorphine, according to a study published in JAMA Psychiatry

The research used data from Medicare fee-for-service beneficiaries ages 18 and older who had received a diagnosis for opioid use disorder based on ICD-10 codes. It was divided into two groups: a prepandemic cohort of 105, 240 beneficiaries and a pandemic cohort of 70, 538. 

Researchers found 19.6% of beneficiaries in the pandemic group received OUD-related telehealth services during the study period, compared with only 0.6% of patients in the prepandemic cohort. They were also more likely to access behavioral health-related virtual care at 41%, compared with 1.9% in the prepandemic group. Additionally, 12.6% of pandemic beneficiaries accessed medications for OUD, like methadone, buprenorphine and extended-release naltrexone, compared with 10.8% of the prepandemic beneficiaries. 

Though the percentage who experienced a medically treated overdose was similar in both groups, the study found receiving OUD-related telehealth was associated with increased odds of continuing to use medications for OUD and lowered odds of overdose. 

“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,” the study’s authors wrote. “Strategies to expand provision of MOUD [medications for opioid use disorder], increase retention in care and address co-occurring physical and behavioral health conditions are urgently needed in the context of an escalating overdose crisis.”

WHY IT MATTERS

Though telehealth did increase access to medications for OUD, the researchers noted that only a small portion of patients received medications on 80% or more of eligible days. 

They also found racial inequities in access to care. Non-Hispanic African American beneficiaries had lower odds of receiving OUD or behavioral health-related telehealth services and lower odds for medication retention. The study also found higher odds of overdose among patients who were non-Hispanic African American, American Indian or Alaska Native, and Asian or Pacific Islander.

However, researchers said their study demonstrates telehealth could be an important way to deliver care to people struggling with opioid use disorder. 

“The expansion of telehealth services for people with substance use disorders during the pandemic has helped to address barriers to accessing medical care for addiction throughout the country that have long existed,” Dr. Wilson Compton, deputy director of the National Institute on Drug Abuse and senior author of the study, said in a statement. “Telehealth is a valuable service and, when coupled with medications for opioid use disorder, can be lifesaving. This study adds to the evidence showing that expanded access to these services could have a longer-term positive impact if continued.”

THE LARGER TREND

The opioid epidemic continues to be a major challenge for public health. According to the CDC, overdose deaths involving opioids increased from an estimated 70,029 in 2020 to 80,816 in 2021.

At the beginning of the COVID-19 pandemic, the Drug Enforcement Administration loosened regulations to allow providers to prescribe controlled substances, like medications for opioid use disorder, without meeting with patients in person during the public health emergency.

The PHE was extended again earlier this summer. Health and Human Services Secretary Xavier Becerra has promised to give providers 60 days’ notice before it expires. 

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