Drug remedy of veterans with opioid use dysfunction elevated throughout the first yr of the pandemic, in keeping with a brand new research, suggesting that the fast shift from in-person to telehealth visits at VA medical facilities enabled sufferers to get entry to care regardless of Covid-related disruptions.
The research, printed Thursday within the American Journal of Psychiatry, discovered that the variety of Veterans Well being Administration sufferers receiving buprenorphine for opioid use dysfunction elevated 14% within the first yr of the pandemic in contrast with the previous 12 months. This coincided with an enormous leap in use of phone and video telehealth visits for prescribing buprenorphine, from 11.9% of visits in March 2019 to 82.6% in February 2021.
Buprenorphine is one among solely two therapies related to diminished mortality amongst folks with opioid use dysfunction and the one one that’s simply accessible at clinics and physician’s places of work.
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The lead researcher, College of Michigan dependancy psychiatrist Allison Lin, acknowledged that it’s troublesome to tease aside the consequences of Covid — resembling a rise in opioid use, overdoses, and wish for care — from the consequences of elevated telehealth use on the rise in persevering with buprenorphine. However clearly telehealth visits performed an essential position in easing entry to remedy at a time when overdose deaths soared.
“We all know that the most important contributor to overdose is ongoing dependancy, together with opioid use dysfunction,” mentioned Lin, who additionally works on the VA Ann Arbor Healthcare System. “We do have some extremely efficient therapies. However the overwhelming majority of individuals with opioid use dysfunction don’t obtain these therapies.”
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It’s troublesome for hospitals to make massive adjustments in a small period of time, however Covid was the “experiment you by no means requested for” that reworked well being care in a single day, Lin mentioned. Starting in March 2020, suppliers had been capable of prescribe buprenorphine with out the preliminary in-person go to usually required for managed substances, utilizing an exception underneath the general public well being emergency declaration. Accompanying coverage adjustments included insurance coverage protection for telehealth appointments.
“It wasn’t simply that individuals had been utilizing extra telehealth, it was that the overwhelming majority of buprenorphine care transitioned to telehealth and essentially the most generally used modality was telephone,” Lin mentioned.
In the course of the pandemic, phone visits had been most used — accounting for 86.7% of visits amongst over 13,000 sufferers persevering with buprenorphine, adopted by video calls, after which in-person visits.
Haiden Huskamp, a professor of well being care coverage at Harvard Medical College who was not affiliated with the analysis, mentioned the dramatic flip in how care is supplied and the variety of audio-only visits is hanging.
Based mostly on the nationwide Veterans Well being Administration information, the general enhance in use was attributed to fewer sufferers discontinuing buprenorphine remedy within the pandemic’s first yr. The variety of sufferers initiating the drug decreased over the identical time interval.
“It’s not clear if these findings generalize to different settings,” mentioned Lori Uscher-Pines, a senior well being coverage researcher on the RAND Company who was not concerned with the research. “The VHA faces fewer boundaries to delivering telehealth visits in excessive quantity and had extra refined telehealth applications previous to the pandemic than different settings.” She added that future analysis ought to deal with what’s driving the pattern towards fewer initiations of buprenorphine remedy.
When the general public well being emergency declaration expires, sufferers counting on telehealth must make in-person visits as soon as once more if the regulation isn’t modified. “I’m undecided what would occur to those sufferers who’ve been receiving their buprenorphine remedy by way of telehealth, who’ve solely recognized care by way of telehealth,” Lin mentioned, advocating for continued use of telehealth after the pandemic ends.
Whereas there have been extra sufferers staying on buprenorphine remedy by means of digital appointments, researchers discovered a drop in different therapies for substance use problems throughout the pandemic.
Given that the majority well being care use — from preventative therapies to look after power situations — decreased throughout the pandemic, Lin mentioned it’s attainable that telehealth insurance policies are extra advanced to implement for types of dependancy like alcohol use which require remedy, not simply remedy.
A standard concern with telehealth is the potential for inappropriate prescribing. Nonetheless, Lin explains there is no proof that in-person visits scale back pointless or dangerous prescriptions neither is there proof that telehealth systematically results in elevated misuse.
“Who the heck cares?” mentioned Ateev Mehrotra, a professor of well being care coverage at Harvard Medical College who research telemedicine, acknowledging that that is his private opinion on a contentious concern. “If one particular person with opioid use dysfunction provides buprenorphine to a different particular person with opioid use dysfunction and diverts it … in the event that they’re utilizing it to manage their withdrawal signs, and so they’re much less probably to make use of heroin or fentanyl and die, possibly this can be a good factor.”
Mehrotra factors out that learning the impact of telehealth on affected person outcomes is difficult as a result of “individuals who use telemedicine are sometimes extra educated, extra refined, they’re actually going to do higher in any case,” and it’s troublesome to discover a managed solution to examine a gaggle of sufferers who obtain telemedicine choices to those that don’t.
