VA Treatment of Opioid Use Disorder was Maintained During the COVID Pandemic Through Rapid Shift to Telehealth
BACKGROUND:
At the beginning of the COVID pandemic (March 2020), key federal policy changes were implemented to decrease barriers to telehealth-delivery of buprenorphine, a life-saving medication treatment for patients with opioid use disorder (OUD). This VA-wide retrospective cohort study examined the impact of these COVID-19 policies on buprenorphine treatment across different modalities (telephone, video, and in-person visits). Using VA data, investigators compared trends in buprenorphine treatment for OUD across the 12 months before (March 2019 to February 2020) and after (March 2020 to February 2021) federal-level COVID-19 policy changes were implemented. Treatment retention and Veteran demographic characteristics were also examined.
FINDINGS:
- Buprenorphine treatment for OUD was maintained during the COVID-19 pandemic – across the VA healthcare system – through a rapid shift to telehealth, at a time when other healthcare delivery decreased.
- The number of Veterans receiving buprenorphine increased from 13,415 in March 2019 to 15,339 in February 2021. By February 2021, phone visits were used by the most patients (50%, 4,456), followed by video (32%, 2,870) and in-person (17%, 1,544).
- Among Veterans receiving a buprenorphine treatment visit each month, the proportion of telehealth visits (phone and video) increased dramatically from 12% in March 2019 to 83% in February 2021.
- The proportion of Veterans reaching 90-day retention on buprenorphine treatment decreased significantly from the pre- to post-pandemic periods (50% to 48%), but days on buprenorphine increased significantly from 204 to 209.
IMPLICATIONS:
- Policy changes that were rapidly implemented to reduce barriers to telehealth allowed continued delivery of buprenorphine treatment. Future changes to these policies (e.g., reversing support for telehealth prescribing of buprenorphine) could have major implications for patient care.
LIMITATIONS:
- It was not possible to include a control group unaffected by COVID-19-related buprenorphine policy changes in this study, as these changes were enacted at the federal level and simultaneously affected all patients with OUD across the country.
- Telehealth use and data on telehealth visits may have varied across VA facilities due to differences in facility-level policies, infrastructure, coding of telehealth visits, and other factors.
AUTHOR/FUNDING INFORMATION:
Dr. Lin is supported by an HSR&D Career Development Award. Drs. Lin, Zhang, and Kim are part of HSR&D’s Center for Clinical Management Research (CCMR) in Ann Arbor, MI.
Lin L, Zhang L, Kim H, and Frost M. Impact of COVID-19 Telehealth Policy Changes on Buprenorphine Treatment for Opioid Use Disorder. The American Journal of Psychiatry. July 28, 2022;online ahead of print.
