During the COVID-19 epidemic, federal emergency powers were used to increase the use of telemedicine for new and ongoing care, including the administration of medications for opioid use disorder (MOUD). For a study, researchers sought to investigate the use of telehealth services, the acquisition and retention of MOUD (methadone, buprenorphine, and extended-release [ER] naltrexone), and overdoses that were treated medically both before and after the COVID-19 epidemic.
Data from the US Centers for Medicare & Medicaid Services from September 2018 to February 2021 were utilized in the exploratory longitudinal cohort research. Medicare fee-for-service beneficiaries 18 years of age and older with an International Statistical Classification of Diseases, Tenth Revision, Clinical Modification OUD diagnosis were divided into 2 cohorts (before the COVID-19 pandemic from September 2018 to February 2020 and during the COVID-19 pandemic from September 2019 to February 2021).
A total of 105,240 beneficiaries made up the pre-COVID-19 pandemic cohort; 61,152 (58.1%) of them were women, 71,152 (67.6%) were between the ages of 45 and 74, and 82,822 (79.5%) were non-Hispanic White. The COVID-19 pandemic cohort consisted of 70,538 recipients; of them, 40,257 (57.1%) were women, 46,793 (66.3%) were between the ages of 45 and 74, and 55,510 (79.7%) were non-Hispanic White. The pandemic cohort got more telehealth services related to OUD (13,829 [19.6%] vs 593 [0.6%]; P<.001), mental health (28,902 [41.0%] vs 1,967 [1.9%]; P<.001), and MOUD (8,854 [12.6%] vs 11,360 [10.8%]; P<.001) throughout the research period than the prepandemic cohort did. Similar numbers of people (18.5% [19,491 of 105,240] in the prepandemic cohort vs. 18.4% [13,004 of 70,538] in the pandemic cohort; P=.65] had an overdose that required medical attention during the study period. Receiving OUD-related telehealth services was linked to higher odds of MOUD retention (aOR, 1.27; 95% CI, 1.14–1.41) and decreased odds of medically treated overdose (aOR, 0.67; 95% CI, 0.63-0.71) in the pandemic cohort. Beneficiaries in the pandemic cohort who received MOUD exclusively from opioid treatment programs (aOR, 0.54; 95% CI, 0.47-0.63) and those who received buprenorphine exclusively from pharmacies (aOR, 0.91; 95% CI, 0.84-0.98) had lower odds of having an overdose that required medical attention than those who did not receive MOUD.
Medicare beneficiaries commencing an episode of OUD-related treatment used emergency authority to increase the use of telemedicine and allow flexibility for MOUD provision during the pandemic, which was linked with increased retention in care and lowered likelihood of medically managed overdose. There was an urgent need for strategies to promote retention in care and boost MOUD provision.
Reference: jamanetwork.com/journals/jamapsychiatry/fullarticle/2795953
