June 16, 2023

Opioid Use Disorder Medication (MOUD) is an evidence-based treatment that is critical to addressing the current overdose crisis in the United States.

Prior to the COVID-19 pandemic, people with opioid use disorder (OUD) had to make in-person visits to qualified and licensed prescribers to initiate buprenorphine MOUD and often daily in-person visits to certified opioid treatment programs to receive methadone MOUD. Early in the pandemic, there were decreases in in-person health care visits, and public health experts were concerned about potential disruptions in MOUD access.

Federal agencies have been working to ease restrictions on MOUD access during the COVID-19 pandemic, and a new study published today in JAMA Health Forum shows that overall MOUD reception remained relatively stable at the start of the pandemic, from March to December 2020, among people enrolled in Medicaid. There has, however, been a decrease in the number of people who have recently started MOUD treatment through in-person visits. This decrease was only partially offset by an increase in the number of people just starting MOUD treatment via telehealth.

Dr. Anna Austin

Dr. Anna Austin

There is a huge unmet need for treatment of opioid use disorder, especially MOUD, said Anna Austin, PhD, lead author of the study and assistant professor at the UNC Gillings School of Global Public Health. A contributing factor to this gap is that MOUD access is heavily regulated, making it difficult for people to enter and stay in treatment. Historically, these regulations have limited the use of telehealth for buprenorphine prescribing and have placed strict limits on take-home doses of methadone.

To prevent potential disruptions to MOUD access during the COVID-19 pandemic, the Drug Enforcement Administration and the Substance Abuse and Mental Health Services Administration waived the requirement for an initial in-person visit for a buprenorphine prescription and increased the permitted duration of employment. home methadone. The Centers for Medicare and Medicaid Services also issued guidance to encourage state Medicaid agencies to set higher reimbursement rates for telehealth visits, including MOUD prescription visits.

Austin led the study to understand potential changes in MOUD reception during the pandemic as part of the Medicaid Outcomes Distributed Research Network (MODRN). MODRN is a collaborative effort to analyze data across multiple states to facilitate learning across Medicaid agencies. Backed by AcademyHealth, MODRN enables efficient, high-quality analyzes of Medicaid data from multiple states while ensuring the security of health information.

The study used Medicaid data from 10 states and examined changes in the number of people who received any MOUD or started a new MOUD treatment through both in-person and telehealth visits from May 2019-February 2020-March 2020- December 2020. It was the first study of its kind to examine Medicaid data for these patient-level changes and review claims for multiple types of MOUDs, including buprenorphine, methadone, and naltrexone.

The results show that monthly rates of MOUD remained stable, but the number of people starting new treatment with MOUD decreased immediately after March 2020, largely due to a reduction in new treatment starts through health care visits. person. While MOUD telehealth initiatives increased immediately after March 2020, this only partially offset the decline in in-person initiatives.

According to Austin, temporary regulatory waivers and expanded reimbursement for telehealth enacted during the COVID-19 pandemic may have supported this continued access to the MOUD for existing patients. These policy changes also likely contributed to the increased use of telehealth to initiate a new MOUD treatment, and this may have helped prevent an even greater decrease in treatment initiations than observed.

These findings across 10 state Medicaid programs provide valuable information to support ongoing discussions about the post-pandemic payment and regulatory environment that can best support access and continuity of MOUD treatment, he said. There are growing calls to maintain regulatory and policy changes that have eased MOUD restrictions beyond the COVID-19 pandemic, particularly amid a worsening overdose crisis.

Austin says that within MODRN, researchers will continue to study the role of telehealth in facilitating access to the MOUD, particularly for populations with longstanding access disparities. Austin also notes the importance of future research to examine potential changes in MOUD access as COVID-19-era telehealth prescribing policies evolve after the COVID-19 public health emergency ended in May 2023 .

Read the full study online.

The research reported in this press release was supported by the National Institutes of Health’s National Institute on Drug Abuse with awards R01DA048533 AND R01DA048029. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Participating States/Universities: The study used data from 10 MODRN participating states: Kentucky, Maine, Maryland, Michigan, North Carolina, Ohio, Pennsylvania, Virginia, West Virginia, and Wisconsin. University partners participating in this study include researchers from the University of Delaware, Harvard Medical School, University of Kentucky, University of Southern Maine, University of Maryland-Baltimore County, University of Michigan, University of North Carolina at Chapel Hill, Northwestern University, The Ohio State University, University of Pittsburgh, University of Utah, Virginia Commonwealth University, West Virginia University and the University of Wisconsin-Madison.

Contact the UNC Gillings School of Global Public Health Communications Team at [email protected].

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