Telehealth visits may improve outcomes for opioid use disorder

A cross-sectional study of U.S. insurance claims found that buprenorphine initiation during a telehealth visit was associated with a 36% lower overdose rate than in person and that patients in the former group were more likely to refill their prescriptions.

Buprenorphine treatment initiated via telehealth was associated with reduced rates of opioid overdose and improved patient engagement, a study found.

Researchers performed a cross-sectional study using deidentified U.S. insurance claims to find adult patients with opioid use disorder who started buprenorphine treatment via telehealth or after an in-person visit between March 1, 2020, and Nov. 30, 2021. Treatment quality outcomes included starting buprenorphine within 14 days of diagnosis, patient engagement (defined as having at least two opioid use disorder-related visits), and refilling a buprenorphine prescription during the study period. Health outcomes included opioid overdose and opioid use disorder-related ED and inpatient visits. Results were published Sept. 5 by the Journal of General Internal Medicine.

Overall, 23,565 adults taking buprenorphine were included, 3,314 (14.1%) of whom were seen via telehealth. People were more likely to use telehealth if they were younger (odds ratio [OR], 0.91 to 0.77), were female (OR, 1.18), lived in the South (OR, 1.63) or Midwest (OR, 1.27), lived in a rural area (OR, 1.12), or had higher income (OR, 1.16). Initiation of buprenorphine treatment within 14 days of diagnosis did not differ significantly between telehealth and in-person patients, but the former were more likely to stay engaged with opioid use disorder treatment (54.5% vs. 48.4%; adjusted OR, 1.29 [95% CI, 1.19 to 1.40]) and to refill a buprenorphine prescription during the study period (83.6% vs. 79.0%; adjusted OR, 1.37 [95% CI, 1.23 to 1.52]). Buprenorphine was associated with a 36% lower overdose rate when prescribed via telehealth versus in person (adjusted incidence rate ratio, 0.64; 95% CI, 0.45 to 0.94). Patients prescribed buprenorphine via telehealth and in person did not differ significantly in opioid use disorder-related ED visits or hospitalizations.

Despite limitations, the researchers wrote, “our findings strengthen the case for the permanent adoption of expanded telehealth services and prescribing flexibilities for MOUD [medications for opioid use disorder treatment]. While future research is needed to understand the long-term implications of telehealth use across opioid use disorder treatment modalities, continuous strategies to expand access to MOUD via telehealth may help maximize pathways of care for patients with opioid use disorder and address the ongoing opioid crisis.”