Telehealth helps people stay in drug treatment, UK study finds

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By Rachel Evans and Elizabeth Chapin
University of Kentucky

Drug users getting buprenorphine treatment for opioid-use disorder through telehealth are slightly more likely to stay in treatment longer than those who start treatment without telehealth, according to a new University of Kentucky study analyzing Medicaid data from 2019-2020 in Kentucky and Ohio.

Published in the American Medical Association journal JAMA Network Open, these findings add to a growing body of evidence demonstrating positive outcomes associated with the use of telemedicine for treatment of opioid-use disorder.

In Kentucky, 48% of those who started buprenorphine treatment via telehealth remained in treatment for 90 continuous days, compared to 44% of those who started treatment in non-telehealth settings. In Ohio, the corresponding figures were 32% and 28%.

“Our study suggests that people who have access to telehealth treatment for addiction seem to do better than those who do not. Our hope is that these findings can help inform future policy,” said Lindsey Hammerslag, an assistant professor in the UK College of Medicine’s Department of Internal Medicine and lead author of the study.

“The findings also emphasize that the benefits of telehealth are not reaching all populations equitably. As we continue to integrate telehealth into standard care, we must also investigate and address the barriers that are preventing people from accessing this helpful and effective form of treatment for opioid use disorder.”

The research was conducted as part of the federally funded HEALing Communities Study by UK and three other universities, the largest addiction prevention and treatment implementation study ever conducted.

Before 2020, people with opioid-use disorder were required to meet in person with a health-care provider to start treatment with buprenorphine. After the onset of the Covid-19 pandemic, the federal government allowed clinicians to remotely prescribe buprenorphine to new patients via telehealth without conducting in-person examinations, as well as expanding payment for telehealth services.

To investigate the impact of these changes on patient outcomes, researchers led by a UK team analyzed Medicaid claims and enrollment data from November 2019 through December 2020, in Kentucky and Ohio. They found that nearly 92,000 people aged 18 to 64 had a buprenorphine prescription in at least one quarter of 2020, and that nearly 43,000 of them started treatment in 2020. They also found significant increases in telemedicine delivery of buprenorphine following the more permissive telehealth flexibilities implemented during the Covid-19 pandemic.

Because starting treatment with buprenorphine via telehealth was rare prior to and during the first quarter of 2020, researchers then looked at a smaller subset of data from individuals who started treatment with buprenorphine in either the second or third quarter of 2020, (including 9,172 people in Kentucky and 12,328 people in Ohio). In both states, starting treatment via telemedicine was associated with higher likelihood of staying on treatment for a continuous 90 days.

The authors also found that receiving buprenorphine treatment via telehealth was not associated with an increased likelihood of nonfatal overdose, providing additional evidence to suggest that patients were not harmed by having increased access to buprenorphine treatment through telemedicine.

Importantly, some groups were less likely to receive treatment for opioid use disorder via telehealth and were less likely to remain in treatment through the continuous 90-day period. These included non-Hispanic Black individuals, men, and those who had experienced a prior overdose involving opioids.

The authors note that additional research is needed to continue to examine the impact of telehealth on patient outcomes, beyond the Medicaid populations in Kentucky and Ohio, and beyond the year 2020.