Pandemic-era telehealth expansion reduced opioid overdoses, study shows

Expanded use of telehealth services during the COVID-19 pandemic was associated with reduced risk of opioid overdoses, a study published in JAMA Psychiatry on Wednesday found.

The study split 175,000 Medicaid beneficiaries between those who initiated opioid use disorder (OUD) care before the pandemic and after the outbreak. Patients in the COVID-19 pandemic group were more likely to receive OUD-related telehealth care and corresponding medications for opioid use disorder (MOUD), experts said. Those who received telehealth care were also more likely to retain medical treatments. Beneficiaries who were Black or lived in the south were less likely to receive telehealth services, the study found.

“The expansion of telehealth services for people with substance use disorders during the pandemic has helped to address barriers to accessing medical care for addiction throughout the country that have long existed,” said Wilson Compton, M.D., deputy director of the National Institute on Drug Abuse and senior author of the study, in a press release. “Telehealth is a valuable service and when coupled with medications for opioid use disorder can be lifesaving. This study adds to the evidence showing that expanded access to these services could have a longer-term positive impact if continued.”

Roughly 1 in 8 beneficiaries in the pandemic group received OUD-related telehealth services compared with 1 in 800 in the prepandemic group, the research revealed. Access to telehealth services was associated with better treatment retention and lower risk of medically treated overdose in the pandemic group compared to those not receiving telehealth services.

“Strategies to increase access to care and MOUD receipt and retention are urgently needed, and the results of this study add to the growing research documenting the benefits of expanding the use of telehealth services for people with OUD,” said lead author Christopher Jones, Pharm.D., Dr. P.H., acting director of the National Center for Injury Prevention and Control at the CDC, in the release about the findings. “The findings from this collaborative study also highlight the importance of working across agencies to identify successful approaches to address the escalating overdose crisis.”

Patient data between September 2018 and February 2021 was analyzed by researchers from multiple federal agencies including the Centers for Disease Control and Prevention, the National Institutes of Health and the Centers for Medicare & Medicaid Services. The findings came on the heels of a study by the Journal of Drug Policy, which found that 86.6% of people do not receive OUD treatment when needed.

At the onset of the pandemic, experts raised concerns that increased stressors including stay-at-home orders would raise the risk of overdoses. Federal emergency authorities invoked during the pandemic helped expand usage of telehealth by 6,176% between 2019 and 2020 in Medicare groups, according to a report from the U.S. Health and Human Services’ Office. Medicare beneficiaries seeking digital behavioral healthcare showed a 3,090% increase.

The American Telemedicine Association and its affiliated trade organization, ATA Action, touted the results of the study as proof of the need to pass bipartisan bill H.R. 4040, the Advancing Telehealth Beyond COVID-19 Act of 2022. The bill would extend telehealth flexibilities until 31 Dec. 2024. H.R. 4040 cleared the house after a 416-12 vote on 27 July and has been received in the senate and referred to the Committee on Finance.

The Biden administration had previously expressed strong support for H.R. 4040.“H.R. 4040 would allow for many critical flexibilities to remain through 2024, including for: 1) Medicare beneficiaries to receive telehealth services from any location, including their homes; 2) more types of medical professionals and facilities like rural health clinics and federally qualified health centers to provide telehealth; and 3) Medicare beneficiaries to receive certain services like evaluation and management services, behavioral health services, and substance use disorder services via audio-only technology,” the administration wrote (PDF) in a July statement.

The bill would allow continued virtual care provided by occupational therapists, physical therapists, speech-language pathologists, audiologists and behavioral health services. It also delays implementation of in-person evaluation requirements for mental health telehealth services until 1 Jan. 2025.

The American Telehelath Association “enthusiastically concurred” with the administration and is continuing its advocacy efforts to ensure that H.R. 4040 reaches the president’s desk. “This study is further proof that President Biden’s administration should work with Congress to make permanent the current Ryan Haight in-person waiver for the remote prescription of clinically appropriate controlled substances," said Kyle Zebley, senior vice president of public policy at the American Telemedicine Association and executive director at ATA Action, in a statement. "The ATA and ATA Action are working with policymakers in both parties to make sure the vulnerable and underserved communities currently benefiting from this in-person waiver do not have their continuity of care interrupted once the COVID-19 Public Health Emergency ends.”