Telehealth May Not Improve Opioid Use Disorder Treatment Quality, Access

A study published in JAMA Network Open earlier this week found that clinical outcomes did not vary among opioid use disorder (OUD) patients receiving treatment from clinicians with high or low telehealth use, with no evidence showing that telehealth increased access or improved the quality of OUD treatment.

According to the Centers for Disease Control and Prevention (CDC), about 2.7 million people in the US reported suffering from OUD in 2020.

In this study, researchers aimed to gather information regarding the relationship between telehealth use and the treatment of OUD. They conducted a cohort study that included data from OptumLabs Data Warehouse.

Researchers included claims for telemedicine visits in both pre-and mid-pandemic periods, defined as March 14, 2019, to March 13, 2020, and March 14, 2020, to March 13, 2021, respectively. The criteria for inclusion in the study as a patient were having OUD and enrollment in commercial insurance or Medicare Advantage plans. Included clinicians were those who provided office-based OUD treatment. The clinicians were then grouped into low, medium, or high telehealth-use groups.

After collecting data, researchers assessed four outcomes: all outpatient visits, the type of OUD visit within 90 data of an index visit, the prescribing of medications for OUD (MOUD), and clinical events related to OUD, such as drug overdose or rehabilitation center stay.

The study population consisted of 11,801 patients who received treatment from 1,768 clinicians. Of these patients, 5,902 were male, and their mean age was 53.9.

Clinicians with low telehealth use reported conducting 2.1 percent of their visits virtually, on average, during the pandemic period. For clinicians with high telehealth use, that figure was 69.5 percent.

Researchers found that although the use of telehealth for OUD increased between the pre-pandemic and mid-pandemic periods, the total visit volume for OUD for each patient episode stayed stable among clinician groups with high and low telehealth use rates.

There were also no reported changes in MOUD initiation between pre- and mid-pandemic periods, as well as MOUD days’ supply and OUD-related clinical events among all patients.

Based on this information, researchers concluded that using telehealth for OUD treatment was an effective alternative to in-person care as clinical outcomes remained relatively similar. However, researchers also noted that there is no evidence suggesting telehealth can increase access to or improve the quality of OUD treatment.

But there are several limitations to the study, including the observational nature of the study, the potential lack of generalizability, and the absence of measurements related to buprenorphine implants, OUD relapse, and patient functioning. Also, overdose rates included only those who initiated treatment for OUD.

Though this study did not show a link between telehealth use and increased OUD treatment access, other research contradicts this finding.

A program developed by Penn Medicine used telehealth to assist OUD patients in accessing care. Known as CareConnect, the virtual program increased assess for OUD patients and boosted buprenorphine prescriptions, the health system stated in NEJM Catalyst.

Researchers found that between November 2021 and September 2022, 89 percent of program participants filled their first buprenorphine prescription, and 55 percent continued a preexisting prescription for the medication at least 30 days after being engaged.