The impact of increased telehealth use on the treatment of substance use disorder during the COVID-19 pandemic

Abstract

Background: The COVID-19 pandemic necessitated a shift from in-person substance use disorder (SUD) treatment to virtual telehealth (TH) visits, creating opportunities to assess the impact of virtual visits on SUD treatment.

Methods: This study utilized retrospective, de-identified, electronic health record (EHR) data from Oracle EHR Real-World Data to examine the impact of TH on SUD treatment. Patients with a qualifying SUD diagnosis from 141 U.S. health systems were included and divided into pre-TH (January 1, 2017 through January 1, 2019) and COVID (January 1, 2020 through January 1, 2022) cohorts. This study analyzed TH utilization, medications for SUD (MSUD) prescribing, drug-related events, and mental health crises, comparing patient outcomes where the treating clinician was a high TH user versus a low TH user in both pre-COVID and COVID periods.

Results: Patients visiting high TH clinicians had lower MSUD prescribing rates, yet a higher MSUD day's supply, and higher rates of TH outpatient visits than those visiting low TH providers, with both groups having an increase in TH visits during the COVID period. Patients with high TH clinicians had lower rates of SUD-related hospitalizations than those with low TH providers but similar rates of drug overdoses, relapses, injection-related infections, and mental health crises.

Conclusions: TH modalities showed increased SUD-related outpatient visits without increasing adverse outcomes, indicating its potential as a sustainable alternative to in-person care. This study highlights the need for further research on TH efficacy for SUD-specific populations and supports the continued integration of telehealth in SUD treatment post-pandemic.

Keywords: COVID-19 pandemic; Drug overdose deaths; Drug-related mortality; Pharmacotherapy; Substance use disorders (SUDs); Telehealth.