Telehealth Buprenorphine Initiation is Associated With Improved Treatment Retention for Individuals With Opioid Use Disorder

In the US, telehealth services were expanded during the COVID-19 pandemic to include prescribing buprenorphine for opioid use disorder (OUD). Two studies used large insurance databases to analyze the association between telehealth buprenorphine initiation and treatment retention and nonfatal overdose. Nguyen et al. performed a cross-sectional study using Medicare Advantage claims from March 2020 to November 2021, and compared in-person (n=9934) and telehealth (n=3314) buprenorphine initiation after balancing group covariates with propensity score matching. Hammerslag et al. performed a retrospective cohort study to compare in-person and telehealth buprenorphine initiations using Medicaid claims data from Kentucky and Ohio from November 2019 to December 2020 (n= 41,266).

• In Nguyen et al., the telehealth group was more likely to be ≥65 years of age, from a rural community, from the Midwest or South, have higher median household income, and lower comorbidity index. After propensity matching, in-person and telehealth groups were similar across all covariates except for comorbidity index, which continued to be lower in the telehealth group.
• In Hammerslag et al., the telehealth buprenorphine group was less likely to include Non-Hispanic Black individuals, and more likely to include individuals with a mental health diagnosis.
• Telehealth initiation was associated with improved treatment retention in both Nguyen et al. (odds ratio [OR], 1.37 for receiving a second buprenorphine refill after initiation) and Hammerslag et al. (Kentucky adjusted OR [aOR], 1.13 and Ohio aOR, 1.19 for continuous retention at least 90 days after initiation).
• Telehealth initiation of buprenorphine was significantly associated with reduced nonfatal opioid overdose in Nguyen et al. (adjusted incidence rate ratio, 0.64), but not in Hammerslag et al.

Comments: These analyses support the expansion of telehealth for treatment of OUD and suggest that telehealth initiation of buprenorphine is at least as effective as in-person initiation and may even lead to better outcomes. The observed improvements may be due to the population differences in those offered telehealth vs in-person initiation. They may also be explained by improved treatment engagement due to more accessible appointments to titrate buprenorphine to an effective dose.

Brigid Adviento, MD, MPH* & Darius A. Rastegar, MD

* 2023–24 Rich Saitz Editorial Intern & Addiction Medicine Fellow, University of Iowa Hospitals and Clinics

References: Nguyen B, Zhao C, Bailly E, Chi W. Telehealth initiation of buprenorphine for opioid use disorder: patient characteristics and outcomes. J Gen Intern Med. 2023 [Epub ahead of print]. doi:10.1007/s11606-023-08383-1.

Hammerslag LR, Mack A, Chandler RK, et al. Telemedicine buprenorphine initiation and retention in opioid use disorder treatment for Medicaid enrollees. JAMA Netw Open. 2023;6(10):e2336914.