Practical Pain Management Vol 23 Issue 1 Feb 2023
Despite an alarming increase in opioid addiction over the past decade, access to treatment for opioid use disorder (OUD) is still limited. Medications including methadone, naltrexone, and buprenorphine have proved beneficial for OUD treatment, however, fewer than 30% of people who need treatment tend to get it.¹
Among the barriers to treatment is a shortage of clinicians trained in OUD and medication-assisted treatment, as well as the cost of medical visits and care. Stigma and transportation issues are also known barriers. Telemedicine has been suggested as a potential solution, but because the approach was rarely used before the pandemic, there was little data on its risks and benefits.
Telemedicine for OUD Makes No Significant Difference
The researchers, based at Boston universities, selected subjects from a national database of insured patients who had coverage from either commercial insurance or Medicare Advantage. Individuals who received medication-based OUD treatment during the pandemic from clinicians with high or medium telehealth use were compared with patients who received treatment during the same period from providers with low telehealth use. The data were then adjusted for outcomes of patients who were treated by the same clinicians pre-pandemic.
Clinicians were most likely to be based in an office rather than in an opioid treatment center. These were primarily primary care physicians, psychiatrists, nurse practitioners, pain medicine specialists, rehabilitation medicine specialists, neurologists, pediatricians, and obstetricians/gynecologists. The total number of clinicians was 1,768, treating a total of 11,801 patients. The study sample included patients with a history of outpatient care, excluding emergency department visits, inpatient stays, and nursing home residence.
The researchers found that the total number of OUD visits was consistent across the pre-pandemic and pandemic periods, potentially indicating that telemedicine substituted rather than supplemented care.
While telemedicine seems to have done no harm, it did not offer additional benefit, according to the findings. Greater use of telemedicine was not associated with increased initiation of medications for OUD (MOUD) or of refills. Medication use for OUD was low pre-pandemic and remained low during the pandemic, despite the increased use of telemedicine for OUD treatment.
In addition, there was no evidence of increased access as measured by the number of telemedicine visits. “While telemedicine access may be part of a comprehensive policy package to promote MOUD access,” the study’s authors wrote, “there is substantial progress still needed to increase access, and telemedicine alone is unlikely to be sufficient.”²
Digital Divide Does Matter
The digital divide may be a factor in these results, wrote the researchers. The sample group receiving care from clinicians with high telemedicine use were concentrated in relatively high income, metropolitan areas with a lower proportion of white residents.²
Sarafina Kankam, MD, assistant professor of anesthesiology and pain medicine specialist at the University of Kansas Medical Center, agreed that the digital divide is a significant issue and would like to see the patient population expanded in future studies, focusing more on rural areas. “The quality of care would likely be the same, she said, “but the bigger question is inequalities in access.”
When it comes to telemedicine, Dr. Kankam said, “the first thing is to really understand the needs of your patient population, and if necessary, work with case management or provide other resources and options that your patients need. As providers, having the flexibility to use telemedicine can have an impact on a lot of our patients’ lives.”
- Mauro PM, Gutkind S, Annunziato EM, Samples H. Use of medication for opioid use disorder among US adolescents and adults with need for opioid treatment, 2019. JAMA Netw Open. 2022 July29;5(7):e2227817. doi:10.1001/jamanetworkopen.2022.3821.
- Hailu R, Mehrotra A, Huskamp HA, et al. Telemedicine use and quality of opioid use disorder treatment in the US during the COVID-19 pandemic. JAMA Netw Open. 2023;6(1):e2252381.
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