In a survey of primary care clinicians, one-third of respondents reported an increase in patients with substance use disorder during the COVID-19 pandemic. Preliminary data indicate the rate of overdose deaths involving opioids increased nationally during the first few months of the COVID-19 pandemic, and modeling suggests opioid overdose rates will remain elevated long after physical distancing orders end. It is essential to ensure treatment for opioid use disorder (OUD) is accessible during and after physical distancing precautions.
The literature shows that Medicaid expansion has resulted in increased OUD treatment utilization and increased access to medications that treat OUD (referred to as MOUD). Medicaid coverage of MOUD and naloxone reached nearly $1.6 billion in 2019, according to this fiscal analysis.
The COVID-19 pandemic, however, and physical distancing and shelter-in-place precautions to mitigate the pandemic have created barriers to treatment for OUD. This workshop discusses how the pandemic has reduced capacity of mental and behavioral health facilities and workers, limiting access to treatment and care, particularly for racial/ethnic minorities.
To mitigate these barriers, Federal policy changes were implemented. This article outlines how Federal agencies eased restrictions for MOUD. The Centers for Disease Control and Prevention released guidance for increased use and coverage of telehealth, and the Centers for Medicare & Medicaid Services has expanded the flexibility of Medicare and Medicaid coverage for telephone and video health visits. The COVID-19 response tracker from America’s Health Insurance Plans shows that private insurance companies have done the same.
States also quickly responded with several policy changes and strategies to enable the adoption, use, and coverage of telehealth for treatment for OUD. Providers can use telemedicine for aspects of treatment that previously required an in-person visit (e.g., initiating buprenorphine and dispensing take-home methadone doses). In addition, patients can obtain larger supplies of medications.
AHRQ has reviewed the evidence and found no difference in retention for OUD treatment when provided via telehealth versus in person. Some behavioral health professionals suggest continued use of remote or hybrid MOUD counseling postpandemic. Potential benefits of continued use of remote or hybrid models include:
- Improved patient retention rates.
- Improved cost and efficiency.
- Improved patient outcomes.
- Improved clinician accountability.
- Increased employee retention.
[The Medication-Assisted Treatment for Opioid Use Disorder Playbook is a practical guide for implementing MAT in primary care and other ambulatory care settings.]