Telehealth Buprenorphine Initiation for Opioid Use Disorder Among American Indian and Alaska Native Veterans, April 2017-March 2023.

Haskins C, Amspoker AB, Walder A, Hogan J, Ecker A, Lindsay J, Shore J. Telehealth Buprenorphine Initiation for Opioid Use Disorder Among American Indian and Alaska Native Veterans, April 2017-March 2023. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. 2025 Jul 10 DOI: 10.1089/tmj.2025.0038.

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Abstract:

To determine whether buprenorphine initiation among American Indian and Alaska Native (AI/AN) Veterans increased with expanded telehealth-prescribing abilities during the COVID-19 pandemic. This cohort study used the Veterans Health Administration medical record system, including 1,761 AI/AN Veterans with a new opioid use disorder (OUD) diagnosis. Exclusion criteria included buprenorphine receipt in the 3 months before diagnosis and methadone use. Primary exposures included time of diagnosis (3 years before vs. during COVID-19 pandemic, April 1, 2020-March 31, 2023), rurality, and telehealth-only versus in-person encounters. Covariates included age, gender, marital status, Deyo-Charlson Comorbidity Index, and psychiatric comorbidities. The primary outcome was buprenorphine initiation, defined by prescription at/after OUD diagnosis. Of 1,761 AI/AN Veterans with OUD, the mean age was 53.8, 58.5% urban residing, and 37.5% married. Depressive (62.8%) and alcohol use disorders (38.9%) were common. The pre-COVID-19 cohort had more in-person opioid encounters (59.8% vs. 35.7%). Buprenorphine was more frequently prescribed in the pre-COVID-19 cohort (18.5% vs. 12.9%). In the adjusted main-effects model, neither time nor rurality was associated with initiation, but in-person encounters were (odds ratio [OR] = 6.09; 95% confidence interval [CI]: 4.24-8.76). Rurality × time effect modification revealed rural Veterans were more likely to initiate buprenorphine than urban Veterans during the pandemic (OR = 1.81, 95% CI: 1.10-2.99). Unadjusted buprenorphine initiation rates decreased during COVID-19 but were ultimately unexplained by time, with only in-person encounters associated with initiation, compared with telehealth alone. Urban Veterans saw a decline, while rural rates remained stable, likely due to less reliance on in-person care. AI/AN Veteran OUD disparities necessitate telehealth optimization and provider education.