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Use of and Retention on Video, Telephone, and In-Person Buprenorphine Treatment for Opioid Use Disorder During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Among Veterans Health Administration patients receiving buprenorphine for opioid use disorder in the year following implementation of COVID-19–related telehealth policies, did patient characteristics and retention differ across treatment modalities?

Findings  In this cross-sectional study of 17 182 patients, patients who were younger, male, Black, unknown race, Hispanic, non–service connected, or with certain comorbidities were significantly less likely to receive telehealth; those who were older, male, Black, non–service connected, or experiencing homelessness and/or housing instability were significantly less likely to receive video compared with telephone-only telehealth. Telehealth was positively associated with retention.

Meaning  These findings suggest that discontinuing or reducing telephone-only access may disrupt treatment for groups with access disparities and that telehealth-delivered buprenorphine may support retention.

Abstract

Importance  The coronavirus disease 2019 (COVID-19) pandemic prompted policy changes to allow increased telehealth delivery of buprenorphine, a potentially lifesaving medication for opioid use disorder (OUD). It is unclear how characteristics of patients who access different treatment modalities (in-person vs telehealth, video vs telephone) vary, and whether modality is associated with retention—a key indicator of care quality.

Objectives  To compare patient characteristics across receipt of different treatment modalities and to assess whether modality was associated with retention during the year following COVID-19–related policy changes.

Design, Setting, and Participants  This cross-sectional study was conducted in the national Veterans Health Administration. Participants included patients who received buprenorphine for OUD during March 23, 2020, to March 22, 2021. Analyses examining retention were stratified by buprenorphine initiation time (year following COVID-19–related changes; prior to COVID-19–related changes).

Exposures  Patient characteristics; treatment modality (at least 1 video visit, at least 1 telephone visit but no video, only in-person).

Main Outcomes and Measures  Treatment modality; 90-day retention.

Results  Among 17 182 patients, 7094 (41.3%) were aged 30 to 44 years and 6251 (36.4%) were aged 45 to 64 years; 15 835 (92.2%) were male, 14 085 (82.0%) were White, and 16 292 (94.8%) were non-Hispanic; 6547 (38.1%) had at least 1 video visit, 8524 (49.6%) had at least 1 telephone visit but no video visit, and 2111 (12.3%) had only in-person visits. Patients who were younger, male, Black, unknown race, Hispanic, non–service connected, or had specific mental health/substance use comorbidities were less likely to receive any telehealth. Among patients who received telehealth, those who were older, male, Black, non–service connected, or experiencing homelessness and/or housing instability were less likely to have video visits. Retention was significantly higher for patients with telehealth compared with only in-person visits regardless of initiation time (for initiated in year following COVID-19–related changes: adjusted odds ratio [aOR], 1.31; 95% CI, 1.12-1.53; for initiated prior to COVID-19–related changes: aOR, 1.23; 95% CI, 1.08-1.39). Among patients with telehealth, higher retention was observed in those with video visits compared with only telephone for patients who initiated in the year following COVID-19 (aOR, 1.47; 95% CI, 1.26-1.71).

Conclusions and Relevance  In this cross-sectional study, many patients accessed buprenorphine via telephone and some were less likely to have any video visits. These findings suggest that discontinuing or reducing telephone access may disrupt treatment for many patients, particularly groups with access disparities such as Black patients and those experiencing homelessness. Telehealth was associated with increased retention for both new and continuing patients.

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Article Information

Accepted for Publication: August 27, 2022.

Published: October 12, 2022. doi:10.1001/jamanetworkopen.2022.36298

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

Corresponding Author: Lewei (Allison) Lin, MD, MS, Department of Psychiatry, University of Michigan, Bldg 16, 2nd Floor, 2800 Plymouth Rd, Ann Arbor, MI 48109 (leweil@med.umich.edu).

Author Contributions: Dr Lin 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.

Concept and design: Frost, Lin.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Frost.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Zhang, Kim.

Obtained funding: Lin.

Administrative, technical, or material support: Lin.

Supervision: Lin.

Conflict of Interest Disclosures: Dr. Lin reported receiving personal fees for consults on telehealth for substance use disorder treatment for Providers Clinical Support System with funding from the Substance Abuse and Mental Health Services Administration, and for National Center for Quality Assurance with funding from Alkermes. No other disclosures were reported.

Funding/Support: Dr Lin is supported by a Career Development Award (CDA 18-008) from the US Department of Veterans Affairs Health Services Research & Development Service and Centers for Disease Control and Prevention grant R49 CE003085. Dr Frost was supported by a predoctoral training award from the Veterans Affairs Puget Sound Research and Development Service at the time this work was conducted.

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

Disclaimer: The opinions expressed in this work are the authors’ and do not necessarily reflect those of the institutions, funders, the Centers for Disease Control and Prevention, the Department of Veterans Affairs, or the United States Government.

Meeting Presentation: Preliminary findings from this study were presented at the 2021 Addiction Health Services Research Conference; October 13 to 15, 2021; virtual.

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