Study Validates Telehealth for Substance Abuse Treatment During Pandemic

A study conducted by researchers from the CDC, CMS, and NIH found that the use of telehealth and digital health tools to provide medication to people with substance abuse issues and monitor treatment during the pandemic helped improve adherence and lower the risk of a medically treated overdose.

A new study led by the Centers for Disease Control and Prevention finds that telehealth services used during the pandemic to help people dealing with substance abuse improved treatment adherence and lowered the odds of a medically treated overdose.

The study, conducted by researchers from the CDC, Centers for Medicare & Medicaid Services (CMS), and National Institutes of Health (NIH) and published in JAMA Psychiatry, focused on how healthcare providers used medications for opioid use disorder (MOUD) during the pandemic to treat some 175,000 Medicare beneficiaries.

Providers took advantage of waivers enacted during the pandemic to prescribe three medications – methadone, buprenorphine, and extended-release naltrexone - via telehealth and manage care for their patients through a variety of channels, including virtual care and audio-only telehealth (often via a telephone). These waivers are currently scheduled to end when the national public health emergency (PHE) is lifted sometime next year.

According to the study, which examined telehealth use between September 2018 and February 2021, the use of telehealth and digital health tools and platforms to treat people dealing with opioid use disorder (OUD) increased 35-fold during the pandemic. Among those using medication assisted treatment (MAT), the study found that treatment retention was the same or higher than those treated prior to the pandemic, often in in-person programs. And the percentage experiencing a medically treated overdose was the same as pre-pandemic levels, even though overdose deaths increased 30% between 2019 and 2020.

On a less-promising note, the study found that only a small portion of both cohorts – pandemic and pre-pandemic – received their medications on at least 80% of eligible days, highlighting the challenges in engaging with patients dealing with substance abuse and keeping them engaged and underscoring the value of digital health tools and platforms that can reach patient when they most need help.

"Our results highlight the continued need for a well-coordinated and comprehensive health system that integrates physical and behavioral health care," researchers concluded in the study. "Beneficiaries in both cohorts had many challenging health conditions—co-occurring SUDs, mental health diagnoses, and chronic medical conditions, including a large majority with chronic pain. Our observations align with the goals specified in the CMS Behavioral Health Strategy and identify opportunities for focused and coordinated actions across clinical settings and healthcare practitioners, including advancing integrated care for co-occurring physical and behavioral health conditions, which is a core component of the 2021 HHS overdose prevention strategy."

The study's results drew the attention of the American Telemedicine Association, one of several organizations lobbying federal officials and Congress to permanently extend waivers for telehealth use and coverage for substance abuse treatment.

"We were heartened to read the significant results from this important study, demonstrating the positive impact telehealth can have on treating individuals with substance abuse disorder,” Kyle Zebley, the ATA's senior vice president of public policy and executive director of ATA Action, said in a press release. “It is important to note that the study reported that telehealth services helped to lower the odds of overdose and increased the use of medications for opioid use disorder (MOUD)."

“We hope this sends a strong signal to policymakers that telehealth can and should be a permanent part of healthcare delivery, to effectively and safely address critical needs of patients and individuals whenever and wherever they need it most,” he added. “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.”