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. 2023 May 1;80(5):508-514.
doi: 10.1001/jamapsychiatry.2023.0310.

Association of Receipt of Opioid Use Disorder-Related Telehealth Services and Medications for Opioid Use Disorder With Fatal Drug Overdoses Among Medicare Beneficiaries Before and During the COVID-19 Pandemic

Christopher M Jones  1 , Carla Shoff  2 , Carlos Blanco  3 , Jan L Losby  1 , Shari M Ling  4 , Wilson M Compton  3
Affiliations

Association of Receipt of Opioid Use Disorder-Related Telehealth Services and Medications for Opioid Use Disorder With Fatal Drug Overdoses Among Medicare Beneficiaries Before and During the COVID-19 Pandemic

Christopher M Jones et al. JAMA Psychiatry. .

Abstract

Importance: Federal emergency authorities were invoked during the COVID-19 pandemic to expand clinical telehealth for opioid use disorder (OUD).

Objective: To examine the association of the receipt of telehealth services and medications for OUD (MOUD) with fatal drug overdoses before and during the pandemic.

Design, setting, and participants: This cohort study used exploratory longitudinal data from 2 cohorts (prepandemic cohort: September 1, 2018, to February 29, 2020; pandemic cohort: September 1, 2019, to February 28, 2021) of Medicare Fee-for-Service beneficiaries aged 18 years or older initiating an episode of OUD-related care using Medicare Fee-for-Service data from the Centers for Medicare & Medicaid Services and National Death Index data from the Centers for Disease Control and Prevention. Data analysis was performed from September 19 to October 17, 2022.

Exposures: Prepandemic vs pandemic cohort demographic, medical, substance use, and psychiatric characteristics.

Main outcomes and measures: Receipt of OUD-related telehealth services, receipt of MOUD, and fatal drug overdose.

Results: The prepandemic cohort comprised 105 162 beneficiaries (58.1% female; 67.6% aged 45-74 years). The pandemic cohort comprised 70 479 beneficiaries (57.1% female; 66.3% aged 45-74 years). The rate of all-cause mortality was higher in the pandemic cohort (99.9 per 1000 beneficiaries; 7041 deaths) than in the prepandemic cohort (76.8 per 1000; 8076 deaths) (P < .001). The rate of fatal drug overdoses was higher in the pandemic cohort (5.1 per 1000 beneficiaries; n = 358) than in the prepandemic cohort (3.7 per 1000; n = 391) (P < .001). The percentage of deaths due to a fatal drug overdose was similar in the prepandemic (4.8%) and pandemic (5.1%) cohorts (P = .49). In multivariable analysis of the pandemic cohort, receipt of OUD-related telehealth was associated with a significantly lower adjusted odds ratio (aOR) for fatal drug overdose (aOR, 0.67; 95% CI, 0.48-0.92) as was receipt of MOUD from opioid treatment programs (aOR, 0.41; 95% CI, 0.25-0.68) and receipt of buprenorphine in office-based settings (aOR, 0.62; 95% CI, 0.43-0.91) compared with those not receiving MOUD; receipt of extended-release naltrexone in office-based settings was not associated with lower odds for fatal drug overdose (aOR, 1.16; 95% CI, 0.41-3.26).

Conclusions and relevance: This cohort study found that, among Medicare beneficiaries initiating OUD-related care during the COVID-19 pandemic, receipt of OUD-related telehealth services was associated with reduced risk for fatal drug overdose, as was receipt of MOUD from opioid treatment programs and receipt of buprenorphine in office-based settings. Strategies to expand provision of MOUD, increase retention in care, and address co-occurring physical and behavioral health conditions are needed.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Compton reported long-term stock holdings in General Electric Co, 3M Companies, and Pfizer Inc outside the submitted work. No other disclosures were reported.

References

    1. Public health emergency. Determination that a public health emergency exists. US Department of Health and Human Services. January 31, 2020. Accessed February 17, 2023. https://www.phe.gov/emergency/news/healthactions/phe/Pages/2019-nCoV.aspx
    1. COVID-19 disaster declarations. Federal Emergency Management Agency (FEMA). Accessed February 17, 2023. https://www.fema.gov/disaster/coronavirus/disaster-declarations
    1. Medicare payment policies during COVID-19. Centers for Medicare and Medicaid Services. Accessed February 17, 2023. https://telehealth.hhs.gov/providers/billing-and-reimbursement/medicare-...
    1. Chu RC, Peters C, De Lew N, Sommers BD. Issue brief: state Medicaid telehealth policies before and during the COVID-19 public health emergency. Assistance Secretary for Planning and Evaluation (ASPE). July 2021. Accessed February 17, 2023. https://aspe.hhs.gov/sites/default/files/2021-07/medicaid-telehealth-bri...
    1. Opioid treatment program (OTP) guidance. March 16, 2020. Substance Abuse and Mental Health Services Administration (SAMHSA). Accessed February 17, 2023. https://www.samhsa.gov/sites/default/files/otp-guidance-20200316.pdf

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