Telehealth for Addiction Treatment Rose Early in the COVID-19 Pandemic

May 24, 2023 - Published in JAMA Network Open, new study findings indicate that insured adults, particularly those who were younger, had higher participation rates in overall and telehealth-enabled addiction treatment following the start of the COVID-19 pandemic.

At the start of the COVID-19 pandemic, there was an unprecedented and widespread shift to virtual care modalities. Although many studies have indicated success associated with telehealth use, researchers aimed to discern its relationship with treatment for addiction. They also sought to determine whether there were differences in addiction treatment utilization after telehealth policy changes by demographics such as age, race, ethnicity, and socioeconomic status.

Researchers conducted a cohort study that examined EHR and claims data from Kaiser Permanente Northern California. All study participants were 18 and older and had issues with drug use either before the COVID-19 pandemic (March 1, 2019, to December 31, 2019) or during the early stages of the pandemic (March 1, 2020, to December 31, 2020).

While analyzing data, researchers used generalized estimating equation models to compare addiction treatment use before and after the pandemic's onset. The Healthcare Effectiveness Data and Information Set of treatment initiation and engagement, retention over 12 weeks, and opioid use disorder (OUD) pharmacotherapy retention were the utilization measures used.

The study population was divided into two cohorts, with the pre-COVID-19 onset group including 19,648 patients and the COVID-19 onset group comprising 16,959 patients.

Except for patients aged 50 and older, the chances of overall treatment initiation increased following the start of the pandemic for all age, race, ethnicity, and socioeconomic status subgroups. In 2019, 25.2 percent of patients with drug use issues engaged in treatment, which increased to 27.7 percent in 2020.

The odds of engaging in telehealth treatment for addiction, however, increased from 7.4 percent in 2019 to 45.9 percent after the start of the pandemic.

In addition to the general increase, the researchers found that those aged 18 to 34 had the sharpest increases in telehealth use. Further, there was no evidence that disparities in addiction treatment were exacerbated, leading researchers to conclude that telehealth could be effective in this type of care.

“It was comforting to know that there was increased utilization even with the pandemic shift to telehealth for some addiction care,” said co-author Asma Asyyed, MD, KPNC chair of addiction medicine and recovery services, in a press release. “We know in addiction medicine that when patients initiate and engage with care they have better outcomes and are less likely to relapse. With opioid use, relapse can be deadly. This study starts the conversation to understand the impact that virtual care has and helps us design a hybrid in-person and telehealth addiction medicine program.”

Prior research has noted success associated with using telehealth to treat addiction disorders, particularly OUD.

As described in NEJM Catalyst in November 2022, a program from the Perelman School of Medicine at the University of Pennsylvania known as CareConnect used telehealth to help OUD patients in accessing care.

Penn Medicine clinicians could virtually assess OUD patients through CareConnect, allowing them to provide patients with buprenorphine prescriptions. According to an assessment conducted by the health system, 89 percent of program participants filled their first buprenorphine prescription between November 2021, when the program launched, and September 2022.