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Toxicology

Receipt of Telehealth Services, Receipt and Retention of Medications for Opioid Use Disorder, and Medically Treated Overdose Among Medicare Beneficiaries Before and During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Psychiatry

Published Online: August 31, 2022

Original Investigation

Article Information and Disclosures

Christopher M. Jones, PharmD, DrPH¹;

Carla Shoff, PhD²;

Kevin Hodges, BS²;

Carlos Blanco, MD, PhD³;

Jan L. Losby, PhD, MSW¹;

Shari M. Ling, MD⁴;

Wilson M. Compton, MD, MPE³

Author Affiliations

¹National Center for Injury Prevention and Control, US Centers for Disease Control & Prevention, Atlanta, Georgia
²Information Products and Analytics Group, US Centers for Medicare & Medicaid Services, Baltimore, Maryland
³National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland
⁴US Centers for Medicare & Medicaid Services, Baltimore, Maryland

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Key Points

Question How were federal emergency authorities to expand telehealth use for substance use disorder treatment and facilitate provision of medications for opioid use disorder (MOUD) used during the COVID-19 pandemic among Medicare beneficiaries with opioid use disorder (OUD)?

Findings In this cohort study including 175 778 beneficiaries, receipt of OUD-related telehealth services during the COVID-19 pandemic was associated with improved MOUD retention and lower odds of medically treated overdose.

Meaning Emergency authorities to expand telehealth utilization and provide MOUD flexibilities during the COVID-19 pandemic were used among Medicare beneficiaries and were associated with improved MOUD retention and lower odds of medically treated overdose, lending support for permanent adoption.

Abstract

Importance Federal emergency authorities were invoked during the COVID-19 pandemic to expand use of telehealth for new and continued care, including provision of medications for opioid use disorder (MOUD).

Objective To examine receipt of telehealth services, MOUD (methadone, buprenorphine, and extended-release [ER] naltrexone) receipt and retention, and medically treated overdose before and during the COVID-19 pandemic.

Design, Setting, and Participants This exploratory longitudinal cohort study used data from the US Centers for Medicare & Medicaid Services from September 2018 to February 2021. Two cohorts (before COVID-19 pandemic from September 2018 to February 2020 and during COVID-19 pandemic from September 2019 to February 2021) of Medicare fee-for-service beneficiaries 18 years and older with an International Statistical Classification of Diseases, Tenth Revision, Clinical Modification OUD diagnosis.

Exposures Pre–COVID-19 pandemic vs COVID-19 pandemic cohort demographic characteristics, medical and substance use, and psychiatric comorbidities.

Main Outcomes and Measures Receipt and retention of MOUD, receipt of OUD and behavioral health-related telehealth services, and experiencing medically treated overdose.

Results The pre–COVID-19 pandemic cohort comprised 105 240 beneficiaries; of these, 61 152 (58.1%) were female, 71 152 (67.6%) were aged 45 to 74 years, and 82 822 (79.5%) non-Hispanic White. The COVID-19 pandemic cohort comprised 70 538 beneficiaries; of these, 40 257 (57.1%) were female, 46 793 (66.3%) were aged 45 to 74 years, and 55 510 (79.7%) were non-Hispanic White. During the study period, a larger percentage of beneficiaries in the pandemic cohort compared with the prepandemic cohort received OUD-related telehealth services (13 829 [19.6%] vs 593 [0.6%]; P < .001), behavioral health-related telehealth services (28 902 [41.0%] vs 1967 [1.9%]; P < .001), and MOUD (8854 [12.6%] vs 11 360 [10.8%]; P < .001). The percentage experiencing a medically treated overdose during the study period was similar (18.5% [19 491 of 105 240] in the prepandemic cohort vs 18.4% [13 004 of 70 538] in the pandemic cohort; P = .65). Receipt of OUD-related telehealth services in the pandemic cohort was associated with increased odds of MOUD retention (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). Among beneficiaries in the pandemic cohort, those receiving MOUD from opioid treatment programs only (aOR, 0.54; 95% CI, 0.47-0.63) and those receiving buprenorphine from pharmacies only (aOR, 0.91; 95% CI, 0.84-0.98) had lower odds of medically treated overdose compared with beneficiaries who did not receive MOUD.

Conclusions and Relevance Emergency authorities to expand use of telehealth and provide flexibilities for MOUD provision during the pandemic were used by Medicare beneficiaries initiating an episode of OUD-related care and were associated with improved retention in care and reduced odds of medically treated overdose. Strategies to expand provision of MOUD and increase retention in care are urgently needed.

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Article Information

Accepted for Publication: June 17, 2022.

Published Online: August 31, 2022. doi:10.1001/jamapsychiatry.2022.2284

Correction: This article was corrected on October 5, 2022, to change the article to open access status under the CC-BY License.

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Jones CM et al. JAMA Psychiatry.

Corresponding Author: Christopher M. Jones, PharmD, DrPH, National Center for Injury Prevention and Control, US Centers for Disease Control & Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341 (fjr0@cdc.gov).

Author Contributions: Dr Shoff had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Ling and Compton jointly share senior authorship.

Study concept and design: All authors.

Acquisition, analysis, or interpretation of data: Jones, Shoff, Hodges, Blanco, Ling, Compton.

Drafting of the manuscript: Jones, Shoff.

Critical revision of the manuscript for important intellectual content: Shoff, Hodges, Blanco, Losby, Ling, Compton.

Statistical analysis: Jones, Shoff.

Administrative, technical, or material support: Hodges, Losby, Ling.

Study supervision: Jones, Hodges, Ling, Compton.

Conflict of Interest Disclosures: Dr Compton reports long-term stock holdings in General Electric Co, 3M Companies, and Pfizer outside the submitted work. No other disclosures were reported.

Funding/Support: This study was sponsored by the US Centers for Disease Control & Prevention, the US Centers for Medicare & Medicaid Services, and the National Institutes of Health.

Role of the Funder/Sponsor: The sponsors reviewed and approved the manuscript. The sponsors had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation of the manuscript; and decision to submit the manuscript for publication.

Disclaimers: The findings and conclusions of this study are those of the authors and do not necessarily reflect the views of the National Institute on Drug Abuse of the National Institutes of Health, the US Centers for Disease Control & Prevention, and the US Department of Health and Human Services.

Additional Contributions: We thank the following staff from the US Centers for Medicare & Medicaid Services for their assistance with this study: Doug Olson, MD, Ellen Blackwell, MSW, Stephanie Bartee, BS, Gloria Wheatcroft, MPH, and Leah Durbak, MPH. None of the contributors were compensated for their work.

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.