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CME / ABIM MOC / CE

Is Telehealth an Effective Strategy for Managing Opioid Use Disorder?

  • Authors: News Author: Megan Brooks; CME Author: Charles P. Vega, MD
  • CME / ABIM MOC / CE Released: 10/21/2022
  • Valid for credit through: 10/21/2023
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

    Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)

    Physician Assistant - 0.25 AAPA hour(s) of Category I credit

    IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit

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Target Audience and Goal Statement

This activity is intended for primary care physicians, nurses/nurse practitioners, physician assistants, pharmacists, psychiatrists, addiction medicine specialists, and other clinicians who use telehealth to manage patients’ opioid use disorder.

The goal of this activity is for learners to be better able to evaluate outcomes of telehealth for opioid use disorder during the COVID-19 pandemic.

Upon completion of this activity, participants will:

  • Analyze the effect and application of medical therapy for opioid use disorder
  • Evaluate outcomes of telehealth for opioid use disorder during the COVID-19 pandemic
  • Outline implications for the healthcare team


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News Author

  • Megan Brooks

    Freelance writer, Medscape

    Disclosures

    Megan Brooks has no relevant financial relationships.

CME Author

  • Charles P. Vega, MD

    Health Sciences Clinical Professor of Family Medicine
    University of California, Irvine School of Medicine

    Disclosures

    Charles P. Vega, MD, has the following relevant financial relationships:
    Consultant or advisor for: GlaxoSmithKline; Johnson & Johnson Pharmaceutical Research & Development, L.L.C.

Editor/Compliance Reviewer

  • Lisa Simani, APRN, MS, ACNP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Lisa Simani, APRN, MS, ACNP, has no relevant financial relationships.

Compliance Reviewer

  • Yaisanet Oyola, MD

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Yaisanet Oyola, MD, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.


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CME / ABIM MOC / CE

Is Telehealth an Effective Strategy for Managing Opioid Use Disorder?

Authors: News Author: Megan Brooks; CME Author: Charles P. Vega, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 10/21/2022

Valid for credit through: 10/21/2023

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Note: The information on the coronavirus outbreak is continually evolving. The content within this activity serves as a historical reference to the information that was available at the time of this publication. We continue to add to the collection of activities on this subject as new information becomes available. It is the policy of Medscape Education to avoid the mention of brand names or specific manufacturers in accredited educational activities. However, manufacturer names related to the approved COVID-19 vaccines are provided in this activity in an effort to promote clarity. The use of manufacturer names should not be viewed as an endorsement by Medscape of any specific product or manufacturer.

Clinical Context

The United States continues to struggle with its legacy of opioid use disorder (OUD), and an editorial by Czeisler, which accompanies the current study, looks back on the toll of the opioid epidemic and some of the challenges in initiating effective medicine for OUD. The rate of drug overdose deaths quadrupled between 1999 and 2019, and it is estimated that there could be as many as 500,000 more overdose deaths in the next decade.

Treatment with medication is considered the standard of care for OUD, and the broad application of medical therapy for OUD could reduce the risk for opioid-related deaths by 25%. However, in 1 study, just 29% of US residents who could benefit from medications for OUD received therapy. This is in large part the legacy of highly restrictive regulations on the use of these medications, but these regulations have eased in the past 2 years. The requirement for in-person assessment before prescribing for medications for OUD was relaxed, and patients are allowed to receive up to 28 days of medication for home use. The requirements for training to prescribe buprenorphine have also been eased to some extent.

Are these changes having the intended effect of increasing adherence to medications for OUD and reducing the number of deaths resulting from overdose? The current study examines a database of patients with Medicare to answer this question.

Study Synopsis and Perspective

A new study provides strong support for the permanent adoption of expanded telehealth services and flexible prescribing of medications for OUD, experts say.

Results showed that expanded access to telehealth services, authorized during the COVID-19 pandemic, led to more Medicare beneficiaries with OUD entering treatment and staying in treatment, as well as to a decline in medically treated overdoses.

This is "really encouraging," lead author Christopher M. Jones, PharmD, acting director of the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC), told Medscape Medical News.

"The findings add to the growing evidence base that pandemic-related changes to facilitate continuity of care for patients with OUD, such as authorities to expand telehealth services, were not only used by patients but also provided benefits to them, helping to build the case for permanent adoption of these flexibilities," said Dr Jones.

The study was a collaborative effort led by researchers at the CDC, the National Institute on Drug Abuse, and the Centers for Medicare and Medicaid Services. It was published online August 31 in JAMA Psychiatry.[1]

Increased Access, Use

The researchers analyzed data for 175,778 Medicare beneficiaries from September 2018 to February 2021.

They focused on receipt of telehealth services and medications for opioid use disorder (MOUD), as well as instances of medically treated overdoses among patients with OUD for whom a new episode of care was initiated either before or during the pandemic.

The prepandemic cohort included 105,240 beneficiaries and the COVID-19 pandemic cohort had 70,538 beneficiaries. The 2 cohorts were similar with respect to sex, age, and race.

A larger percentage of the pandemic cohort received OUD-related telehealth services than did the prepandemic cohort (19.6% vs 0.6%; P<.001), as well as behavioral health-related telehealth services (41.0% vs 1.9%; P<.001) and MOUD (12.6% vs 10.8%; P<.001).

Receipt of OUD-related telehealth services by participants in the pandemic cohort was associated with significantly better retention in MOUD treatment (adjusted odds ratio [aOR], 1.27; 95% CI, 1.14-1.41) and lower odds of medically treated overdose (aOR, 0.67; 95% CI, 0.63-0.71).

In line with the broadening of telehealth access and use during the pandemic, about 1 in 8 beneficiaries in the pandemic cohort received OUD-related telehealth services at their initial OUD visit compared with only 1 in 800 beneficiaries in the prepandemic period.

The percentage of beneficiaries who received OUD-related telehealth services was 35-fold higher in the pandemic than in the prepandemic cohort.

"Valuable" Evidence

"[T]hese findings support permanent adoption of expanded telehealth access and prescribing flexibilities," Mark Czeisler, PhD, Harvard Medical School, Boston, Massachusetts, and Turner Institute for Brain and Mental Health at Monash University, Melbourne, Australia, writes in an accompanying editorial.[2]

The investigators have provided "valuable evidence of means to improve medication retention and reduce medically treated overdoses," he notes.

"Permanent expansion of telehealth services and medication dispensing flexibilities--with widespread adoption of these measures--would facilitate 2 effective strategies to combat the opioid epidemic," Dr Czeisler writes.

Although Dr Jones agrees, he said, "Given the escalating overdose crisis, it is critical that efforts to expand telehealth services are pursued in tandem with efforts to expand equitable access to and provision of evidence-based treatment and improve retention in care and services."

The study was sponsored by the Centers for Disease Control and Prevention, the Centers for Medicare and Medicaid Services, and the National Institutes of Health. Dr Jones and Dr Czeisler have reported no relevant financial relationships.

JAMA Psychiatry. Published online August 31, 2022.

Study Highlights

  • Researchers used several Medicare databases to complete their study. All study subjects were Medicare participants at least 18 years of age and had a new diagnosis of OUD in the system.
  • A pre-COVID-19 cohort of patients with information from September 2018 to February 2020 was compared with a pandemic cohort diagnosed from September 2019 to February 2021.
  • There were 3 main study outcomes: the receipt of telehealth services, the receipt of medication to treat OUD, and the rate of overdose requiring treatment with rescue medication. Medical treatment could entail methadone, extended-release naltrexone, or buprenorphine. Rates of telehealth services and medically treated overdose were determined through patient billing codes.
  • The study analysis compared the main outcomes in the prepandemic and pandemic cohorts, with adjustment for demographic and clinical characteristics.
  • The prepandemic cohort included 105,240 patients, 58.1% of whom were female. The postpandemic cohort included 40,257 patients, of whom 57.1% were female. Approximately two thirds of patients were between the ages of 45 and 74 years, and nearly 80% were White.
  • Other substance use disorders and both psychiatric and physical illness were common in both cohorts.
  • Rates of receiving any telehealth services were 2.5% and 68.6% in the prepandemic and pandemic cohorts, respectively. The respective rates for OUD-related telehealth services were 0.6% and 19.6%.
  • Telehealth service for substance use or behavioral issues was more common among women and persons younger than 65 years. The highest rates of these services were found in the Northeast, and African American patients were less likely to receive telehealth compared with White patients.
  • Rates of receiving medication for OUD at the baseline visits were 4.4% and 7.5% in the prepandemic and pandemic cohorts, respectively (P<.001). This was primarily a result of a higher rate of methadone treatment in an opioid treatment center.
  • In contrast, the rate of buprenorphine and extended-release naltrexone prescriptions in pharmacies fell during the pandemic.

Table 1. Use of Telehealth and Medication for OUD Before and During the COVID-19 Pandemic

  Prepandemic cohort (N = 105,240) COVID-19 pandemic cohort (N = 70,538) P value
Receipt of telehealth services from baseline through follow-up period
Any telehealth service 2.5% 68.6% <.001
Behavioral health-related telehealth service 1.9% 41.0% <.001
OUD-related telehealth service 0.6% 19.6% <.001
Receipt of medication for OUD
At baseline 4.4% 7.5% <.001
From baseline through follow-up 10.8% 12.6% <.001
  • Adherence of at least 80% to buprenorphine doses increased modestly but significantly when comparing the prepandemic period (31.1%) with the postpandemic period (33.3%).
  • OUD-related telehealth services were associated with an adjusted OR of 1.27 (95% CI, 1.11-1.41) for adherence of at least 80% to medication for OUD during the pandemic period.
  • The rates of medically treated overdose were similar in the prepandemic and pandemic periods (slightly more than 18% of the cohort).
  • Variables associated with a lower risk for medically treated overdose included receiving OUD-related telehealth services (aOR, 0.67; 95% CI, 0.63-0.71), receiving medical treatment at an opioid treatment program only (aOR, 0.54; 95% CI, 0.47-0.63), and receiving buprenorphine from a pharmacy only (aOR, 0.91; 95% CI, 0.84-0.98).
  • African American and Asian/Pacific Islander race were associated with higher risks of medically treated overdose.

Clinical Implications

  • The broad application of medical therapy for OUD could reduce the risk for opioid-related deaths by 25%. However, in 1 study, just 29% of US residents who could benefit from medications for OUD received therapy. This is in large part the legacy of highly restrictive regulations on the use of these medications, but these regulations have eased in the past 2 years. The requirement for in-person assessment before prescribing for medications for OUD was relaxed, and patients are allowed to receive up to 28 days of medication for home use.
  • The current study demonstrates that telehealth visits for OUD were associated with increased adherence to buprenorphine and a lower risk for medically treated overdose during the COVID-19 pandemic.

Implications for the Healthcare Team

The healthcare team should consider telehealth an effective means to treat OUD.

 

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