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Telehealth support for veterans with opioid use disorder during COVID

DrTreatment rugs for veterans with opioid use disorder increased during the first year of the pandemic, according to a new study, suggesting that a rapid shift from in-person visits to telehealth at VA medical centers enabled patients to access care despite Covid related disorders.

The study, published Thursday in the American Journal of Psychiatry, found that the number of Veterans Health Administration patients receiving buprenorphine for opioid use disorder rose 14% in the first year of the epidemic compared with the previous 12 months. This coincided with a huge jump in the use of telephone and video health service visits to prescribe buprenorphine, from 11.9% of visits in March 2019 to 82.6% in February 2021.

Buprenorphine is one of only two treatments associated with lower mortality among people with opioid use disorder and is the only treatment that is easily accessible in clinics and doctors’ offices.

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The lead researcher, University of Michigan addiction psychiatrist Alison Lane, admitted that it’s difficult to separate the effects of Covid — such as increased opioid use, overdoses, and need for care — from the effects of increased use of telehealth on the rise in continued buprenorphine. But it is clear that telehealth visits have played an important role in facilitating access to treatment at a time when deaths from overdose are on the rise.

“We know that the biggest contributor to overdose is ongoing addiction, including opioid use disorder,” said Lynn, who also works at the VA Ann Arbor Healthcare System. We have some very effective treatments. But the vast majority of people with opioid use disorder do not receive these treatments.”

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Lin said it’s hard for hospitals to make big changes in a short period of time, but that Covid was the “experience you never asked for” that changed healthcare overnight. As of March 2020, providers were able to prescribe buprenorphine without the initial in-person visit normally required for a controlled substance, using an exception under the declaration of a public health emergency. The changes accompanying the policy included insurance coverage for telehealth appointments.

“It was not just that people were using more telehealth, but the vast majority of buprenorphine care had moved to telehealth and the method most used was the phone,” Lin said.

During the epidemic, phone visits were the most frequently used – accounting for 86.7% of visits among the more than 13,000 patients who continued to use buprenorphine, followed by video calls, and then in-person visits.

The dramatic reversal in how care is delivered and the number of audio-only visits are startling, said Hayden Hoskamp, ​​a professor of health care policy at Harvard Medical School who was not involved in the research.

Based on VA data, the overall increase in use is attributable to a smaller number of patients who discontinued buprenorphine treatment in the first year of the epidemic. The number of patients who started the medication during the same time period decreased.

“It is not clear whether these findings are generalizable to other settings,” said Lori Uscher-Pines, a health policy researcher at the RAND Corporation who was not involved in the study. “VHA faces fewer barriers to delivering telehealth visits in large volumes and has more sophisticated telehealth programs before the pandemic than other places.” She added that future research should address what is driving the trend towards fewer initiations of buprenorphine treatment.

When the public health emergency declaration expires, patients who rely on telehealth will have to make in-person visits again if the law is not changed. “I’m not sure what will happen to those patients who receive buprenorphine via telehealth who only knew telehealth,” Lin said, calling for continued use of telehealth after the pandemic ends.

While there were more patients staying on buprenorphine treatment through virtual appointments, researchers found a decline in other treatments for substance use disorders during the pandemic.

Given that most healthcare uses — from preventive treatments to care for chronic conditions — have declined during the pandemic, Lin said it’s possible that telehealth policies may be more complex to implement for forms of addiction such as alcohol abuse that require treatment, not just medications.

A common concern with telehealth is the possibility of prescribing inappropriate medications. However, Lin explains that there is no evidence that in-person visits reduce unnecessary or harmful prescriptions and no evidence that telehealth systematically increases abuse.

“who cares?” Atif Mehrotra, a professor of health care policy at Harvard Medical School who studies telemedicine, said acknowledging that this is his personal opinion on a contentious issue. “If someone with an opioid use disorder gives buprenorphine to another person with an opioid use disorder and they switch it … if they’re using it to control withdrawal symptoms, and they’re less likely to use heroin or fentanyl and die, that’s probably a good thing.”

Mehrotra notes that studying the impact of telehealth on patient outcomes is challenging because “people who use telemedicine are usually more educated and complex, and will do better anyway,” and it is difficult to find an exact way to compare a group of patients receiving options Telemedicine for those who don’t.

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