Telehealth Could Help Medicaid Patients Treat Opioid Use Disorder, Study Finds

Dive Brief:

• Medicaid beneficiaries who began using buprenorphine, a medication that treats opioid use disorder, via telemedicine early in the COVID-19 pandemic were more likely to stay in treatment than non-telemedicine initiation, according to a study published in JAMA Network Open.
• The study found enrollees faced the same odds of non-fatal overdose when starting buprenorphine through telehealth, suggesting virtual care can improve access to treatment — which can be a major challenge for people who struggle with the disorder.
• The research comes as permanent regulations for telehealth prescriptions of controlled substances remain up in the air. The Drug Enforcement Administration and the HHS announced earlier this month they’ll temporarily extend the pandemic-era flexibilities through 2024.

Dive Insight:

Drug overdose deaths increased during the COVID-19 pandemic, reaching more than 100,000 in 2021, according to the Centers for Disease Control and Prevention. More than 75% of those deaths involved opioids.

Stay-at-home orders and social distancing disrupted healthcare delivery, which might have contributed to the increase in overdose deaths, noted the JAMA study’s authors.

In a bid to avoid lapses in care, regulators and lawmakers created new telehealth rules, like reimbursing visits at the same rate as in-person care and waiving licensing requirements for out-of-state clinicians.

The DEA also granted exceptions to the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which required most practitioners to have at least one in-person evaluation before prescribing controlled substances like buprenorphine.

Those prescription flexibilities were originally set to expire in May alongside the rest of the public health emergency. However, the rules were instead extended until November after regulators received more than 38,000 public comments on proposed rules that would have added more limitations to telehealth controlled substance prescriptions.

Earlier this month, the rules were temporarily extended again through the end of 2024, after organizations like the American Telemedicine Association and the American Hospital Association argued that in-person requirements could limit access to care, particularly for opioid use disorders.

The latest JAMA study, which used Medicaid data on more than 91,000 people from Kentucky and Ohio, is in line with previous research that found expanded telehealth services could improve care for people with opioid use disorder.

“This finding may be especially valuable for improving MOUD [medications for opioid use disorder] access in states such as Kentucky, which has historically had restrictive buprenorphine access policies and restrictive methadone regulations, as well as a large rural population,” the study’s authors wrote. “Telemedicine may also increase access in underserved areas, adding to the workforce for behavioral health services in rural areas.”

However, researchers did note racial disparities when it came to telehealth access and retention. Non-Hispanic Black people had lower odds of telemedicine initiation compared with White individuals, and about half the odds of being retained in buprenorphine treatment at 90 days.

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