Pandemic policy changes may help maintain access to treatment for opioid use disorders

June 16, 2023

Medical therapy for opioid use disorder (MOUD) is an important evidence-based treatment for addressing the current overdose crisis in the United States.

Prior to the COVID-19 pandemic, patients with opioid use disorder (OUD) had in-person visits with trained and licensed prescribers to initiate buprenorphine MOUD and receive methadone MOUD. required daily in-person visits to a licensed opioid treatment program. In the early days of the pandemic, in-person visits to medical facilities had declined, and public health experts were concerned that his access to MOUD could be disrupted.

Federal agencies have worked to ease restrictions on access to MOUD during the COVID-19 pandemic. published today JAMA Health Forum It shows that overall MOUD reception remained relatively stable early in the pandemic from March to December 2020 among those enrolled in Medicaid. However, the number of people newly starting MOUD treatment through in-person visits has decreased. This decline was only partially offset by an increase in the number of people re-starting her MOUD treatment via telemedicine.

Dr. Anna Austin

“There is a large unmet need for treatments for opioid use disorders, especially MOUD,” he said. Dr. Anna Austin, lead author of the study and assistant professor at the UNC Gillings School of International Public Health. “One of the factors contributing to this gap is that access to MOUD is highly regulated, making it difficult for people to stay on treatment. We have limited the use of telemedicine for prescriptions and have placed strict limits on take-home doses of methadone.”

To prevent potential disruptions to access to MOUD during the COVID-19 pandemic, the Drug Enforcement Administration and Substance Abuse and Mental Health Services have waived the initial in-person visit requirement for buprenorphine prescriptions, Extended acceptable duration of use. home methadone. The Centers for Medicare and Medicaid Services also issued guidance encouraging state Medicaid agencies to set higher reimbursement rates for telemedicine visits, including visits for MOUD prescriptions.

Austin led a study to understand potential changes in MOUD receipts during the pandemic as part of the Medicaid Outcomes Distributed Research Network (modern). MODRN is a collaborative effort to analyze data across multiple states to facilitate learning among Medicaid agencies. With the help of AcademyHealth, MODRN will enable efficient, high-quality analysis of Medicaid data from multiple states while ensuring the security of medical information.

This study used Medicaid data from 10 states and received MOUD from May 2019 to February 2020, March 2020 to December 2020 for both in-person and telemedicine, or MOUD We examined changes in the number of people starting new treatment with The first study of its kind to examine Medicaid data on these changes at the patient level and examine multiple types of MOUD claims, including buprenorphine, methadone, and naltrexone.

The results show that although monthly MOUD rates have remained stable, the number of new MOUD treatment starts declined immediately after March 2020, largely due to a decline in new treatment starts through face-to-face consultations. is. His MOUD initiations via telemedicine increased shortly after March 2020, but this only partially offset the decline in in-person initiations.

Temporary deregulations and expanded reimbursement for telemedicine that came into effect during the COVID-19 pandemic may have supported consistent access to MOUD for existing patients, Austin said. These policy changes may also have contributed to the increased use of telemedicine to initiate new MOUD treatments, which may have helped prevent an even greater decrease in treatment initiation than observed. There is a nature.

“These results across 10 state Medicaid programs contribute valuable information to support the ongoing debate about a post-pandemic regulatory and payment environment that can best support access and continuation of MOUD care,” she said. said. there is ” calls on the rise Maintain regulatory and policy shifts that ease restrictions on MOUD after the COVID-19 pandemic, especially as the overdose crisis worsens. ”

Austin said researchers within MODRN will continue to study the role of telemedicine in facilitating access to MOUD, particularly in populations with long-standing disparities in access. Austin will also examine potential changes in MOUD access as COVID-era telemedicine prescribing policies evolve after the end of the COVID-19 public health emergency in May 2023. He also mentions the importance of future research.

Read the full study online.

Research reported in this press release was supported by the National Institute on Drug Abuse at the National Institutes of Health under award number. R01DA048533 and R01DA048029. The content is the sole responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Participating states/universities: In this study, 10 states participating in MODRN (Kentucky, Maine, Maryland, Michigan, North Carolina, Ohio, Pennsylvania, Virginia, West Virginia, Wisconsin) data was used. University partners participating in this study include 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, Ohio State University, University of Pittsburgh, University of Utah, Virginia Commonwealth University, West Virginia University, University of Wisconsin-Madison.

Please contact the UNC Gillings School of Global Public Health Communications Team. [email protected].