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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]

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.

"[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.

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.

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