The COVID-19 pandemic has led to the rapid and widespread adoption of telehealth services. Telehealth may aid in bridging gaps in access to care. The specific impact of telehealth on opioid use disorder (OUD) and its treatment remains uncertain.
Methods:
A retrospective review of commercial insurance claim records within the United States was conducted to investigate the association between the COVID-19 pandemic and changes in the rates of(a) OUD treatments with and without telehealth support and (b) prescriptions for medications for opioid use disorder (MOUD) with and without telehealth support among individuals diagnosed with OUD.
Results:
In a study population of 1,340,506 individuals, OUD diagnosis rates were 5 per 1,000 in-person and 1 per 1,000 via telehealth. COVID-19 decreased in-person OUD diagnoses by 0.89 per 1,000, while telehealth diagnoses increased by 0.83 per 1,000. In-person MOUD treatment rates increased by 0.07 per 1,000 during COVID-19, while telehealth rates remained low. The onset of COVID-19 saw a 1.13 per 1,000 higher increase in telehealth-supported MOUD treatment compared to solely in-person treatment.
Conclusions:
A retrospective review of commercial insurance claim records within the United States was conducted to investigate the association between the COVID-19 pandemic and changes in the rates of (a) OUD treatments with and without telehealth support and (b) prescriptions for MOUD with and without telehealth support among individuals diagnosed with OUD.
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References
1.
StrangJ, VolkowND, DegenhardtL, et al.Opioid use disorder. Nat Rev Dis Primers, 2020; 6(1):3; doi: 10.1038/s41572-019-0137-5
2.
WilsonN, KariisaM, SethP, et al.Drug and opioid-involved overdose deaths—United States, 2017–2018. MMWR Morb Mortal Wkly Rep, 2020; 69(11):290–297; doi: 10.1558/5/mmwr.mm6911a4
3.
FlorenceC, LuoF, RiceK. The economic burden of opioid use disorder and fatal opioid overdose in the United States, 2017. Drug Alcohol Depend, 2021; 218:108350; doi: 10.1016/j.drugalcdep.2020.108350
4.
AyangaD, ShorterD, KostenTR. Update on pharmacotherapy for treatment of opioid use disorder. Expert Opin Pharmacother, 2016; 17(17):2307–2318; doi: 10.1080/14656566.2016.1244529
5.
LuoF, LiM, FlorenceC. State-Level economic costs of opioid use disorder and fatal opioid overdose - United States, 2017. MMWR Morb Mortal Wkly Rep, 2021; 70(15):541–546; doi: 10.1558/5/mmwr.mm7015a1
6.
SkolnickP. The opioid epidemic: Crisis and solutions. Annu Rev Pharmacol Toxicol, 2018; 58(1):143–159; doi: 10.1146/annurev-pharmtox-010617-052534
7.
BellJ, StrangJ. Medication treatment of opioid use disorder. Biol Psychiatry, 2020; 87(1):82–88; doi: 10.1016/j.biopsych.2019.06.020
8.
ChenQ, LarochelleMR, WeaverDT, et al.Prevention of prescription opioid misuse and projected overdose deaths in the United States. JAMA Netw Open, 2019; 2(2):e187621; doi: 10.1001/jamanetworkopen.2018.7621
9.
OmboniS, PadwalRS, AlessaT, et al.The worldwide impact of telemedicine during COVID-19: Current evidence and recommendations for the future. Connected Health, 2022; 1:7–35; doi: 10.2051/7/ch.2021.03
10.
DhaliwalJK, HallTD, LaRueJL, et al.Expansion of telehealth in primary care during the COVID-19 pandemic: Benefits and barriers. J Am Assoc Nurse Pract, 2022; 34(2):224–229; doi: 10.1097/JXX.0000000000000626
11.
SoliminiR, BusardòFP, GibelliF, et al.Ethical and legal challenges of telemedicine in the Era of the COVID-19 pandemic. Medicina (B Aires), 2021; 57(12):1314; doi: 10.3390/medicina57121314
12.
CHANGJE, LAI AYGU, PTAA, et al.Rapid transition to telehealth and the digital divide: Implications for primary care access and equity in a post-COVID era. Milbank Q, 2021; 99(2):340–368; doi: 10.1111/1468-0009.12509
FieldsBG. Regulatory, legal, and ethical considerations of telemedicine. Sleep Med Clin, 2020; 15(3):409–416; doi: 10.1016/j.jsmc.2020.06.004
15.
ChanAH. Logistics of rehabilitation telehealth. Phys Med Rehabil Clin N Am, 2021; 32(2):429–436; doi: 10.1016/j.pmr.2021.01.006
16.
CitoniB, FigliuzziI, PrestaV, et al.Home blood pressure and telemedicine: A modern approach for managing hypertension during and after COVID-19 pandemic. High Blood Press Cardiovasc Prev, 2022; 29(1):1–14; doi: 10.1007/s40292-021-00492-4
17.
TaubenDJ, LangfordDJ, SturgeonJA, et al.Optimizing telehealth pain care after COVID-19. Pain, 2020; 161(11):2437–2445; doi: 10.1097/j.pain.0000000000002048
18.
Centers for Medicare and Medicaid Services. Medicare Telemedicine Health Care Provider Fact Sheet. Baltimore, MD; 2020.
19.
SarayaniA, WangX, ThaiTN, et al.Impact of the transition from ICD-9-CM to ICD-10-CM on the identification of pregnancy episodes in us health insurance claims data. Clin Epidemiol, 2020; 12:1129–1138; doi: 10.2147/CLEP.S269400
20.
MollK, WongHL, FingarK, et al.Validating claims-based algorithms determining pregnancy outcomes and gestational age using a linked claims-electronic medical record database. Drug Saf, 2021; 44(11):1151–1164; doi: 10.1007/s40264-021-01113-8
21.
MacDonaldSC, CohenJM, PanchaudA, et al.Identifying pregnancies in insurance claims data: Methods and application to retinoid teratogenic surveillance. Pharmacoepidemiol Drug Saf, 2019; 28(9):1211–1221; doi: 10.1002/pds.4794
22.
von ElmE, AltmanDG, EggerM, et al.The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Int J Surg, 2014; 12(12):1495–1499; doi: 10.1016/j.ijsu.2014.07.013
AlderksC. Trends in the Use ofMethadone, Buprenorphine, and Extended-Release Naltrexone at Substance Abuse Treatment Facilities: 2003–2015 (Update) - The CBHSQ Report. Rockville, MD; 2017.
25.
HagemanTM, PalmerJ, MullickP, et al.A Buprenorphine Program Evaluation Before and During the COVID-19 Pandemic. J Nurse Pract, 2022; 18(3):267–271; doi: 10.1016/j.nurpra.2021.12.025
26.
WeintraubE, GreenblattAD, ChangJ, et al.Expanding access to buprenorphine treatment in rural areas with the use of telemedicine. Am J Addict, 2018; 27(8):612–617; doi: 10.1111/ajad.12805
27.
HunterSB, DoppAR, OberAJ, et al.Clinician perspectives on methadone service delivery and the use of telemedicine during the COVID-19 pandemic: A qualitative study. J Subst Abuse Treat, 2021; 124:108288; doi: 10.1016/j.jsat.2021.108288
28.
RahmanF, EvansN, BernhardtJ. Access to OUD treatment and maintenance of sobriety amid the COVID-19 pandemic. Subst Use Misuse, 2021; 56(7):1005–1009; doi: 10.1080/10826084.2021.1901935
29.
BalestraM. Telehealth and legal implications for nurse practitioners. J Nurse Pract, 2018; 14(1):33–39; doi: 10.1016/j.nurpra.2017.10.003
30.
PowellRE, HenstenburgJM, CooperG, et al.Patient perceptions of telehealth primary care video visits. Ann Fam Med, 2017; 15(3):225–229; doi: 10.1370/afm.2095
31.
LurieN, CarrBG. The role of telehealth in the medical response to disasters. JAMA Intern Med, 2018; 178(6):745; doi: 10.1001/jamainternmed.2018.1314
32.
ZhangT, MosierJ, SubbianV. Identifying barriers to and opportunities for telehealth implementation amidst the COVID-19 pandemic by using a human factors approach: A leap into the future of health care delivery?. JMIR Hum Factors, 2021; 8(2):e24860; doi: 10.2196/24860
LinLA, ZhangL, KimHM, et al.Impact of COVID-19 telehealth policy changes on buprenorphine treatment for opioid use disorder. Am J Psychiatry, 2022; 179(10):740–747; doi: 10.1176/appi.ajp.21111141
37.
AmramO, AmiriS, PanwalaV, et al.The impact of relaxation of methadone take-home protocols on treatment outcomes in the COVID-19 era. Am J Drug Alcohol Abuse, 2021; 47(6):722–729; doi: 10.1080/00952990.2021.1979991
38.
LivingstonNA, AmeralV, BanducciAN, et al.Unprecedented need and recommendations for harnessing data to guide future policy and practice for opioid use disorder treatment following COVID-19. J Subst Abuse Treat, 2021; 122:108222; doi: 10.1016/j.jsat.2020.108222
39.
Uscher-PinesL, RajaP, MehrotraA, et al.Health center implementation of telemedicine for opioid use disorders: A qualitative assessment of adopters and nonadopters. J Subst Abuse Treat, 2020; 115:108037; doi: 10.1016/j.jsat.2020.108037
40.
AustinAE, TangL, KimJY, et al.Trends in use of medication to treat opioid use disorder during the COVID-19 pandemic in 10 state medicaid programs. JAMA Health Forum, 2023; 4(6):e231422; doi: 10.1001/jamahealthforum.2023.1422
41.
HailuR, MehrotraA, HuskampHA, et al.Telemedicine use and quality of opioid use disorder treatment in the US during the COVID-19 pandemic. JAMA Netw Open, 2023; 6(1):e2252381; doi: 10.1001/jamanetworkopen.2022.52381
MahmoudH, NaalH, WhaibehE, et al.Telehealth-based delivery of medication-assisted treatment for opioid use disorder: A critical review of recent developments. Curr Psychiatry Rep, 2022; 24(9):375–386; doi: 10.1007/s11920-022-01346-z
44.
LarochelleMR, JonesCM, ZhangK. Change in opioid and buprenorphine prescribers and prescriptions by specialty, 2016–2021. Drug Alcohol Depend, 2023; 248:109933; doi: 10.1016/j.drugalcdep.2023.109933
45.
GresslerLE, ShahS, ShayaFT. Association of criminal statutes for opioid use disorder with prevalence and treatment among pregnant women with commercial insurance in the United States. JAMA Netw Open, 2019; 2(3):e190338; doi: 10.1001/jamanetworkopen.2019.0338
46.
LewisKN, GoudieA, WilsonJC, et al.Inequities in telehealth use associated with payer type during the COVID-19 pandemic. Telemed J E Health, 2022 [Epub ahead of print]; doi: 10.1089/tmj.2021.0618
47.
HaleemA, JavaidM, SinghRP, et al.Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sens Int, 2021; 2:100117; doi: 10.1016/j.sintl.2021.100117
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