Risk of Fatal Overdose Decreased With Expanded Access to Telehealth, Medications for OUD During Pandemic

A new study published in JAMA Psychiatry indicates Medicare beneficiaries were less likely to experience a fatal drug overdose as telehealth services and medications for opioid use disorder (OUD) became increasingly available during the COVID-19 pandemic.

"During the COVID-19 pandemic, federal actions were taken to facilitate access to care for individuals with [OUD], including expanded telehealth, remote prescribing of buprenorphine, and expanded take-home doses of methadone from opioid treatment programs,” researchers said.¹

Researchers conducted the national study to examine the correlation between fatal drug overdoses and the receipt of telehealth services and medications for OUD before and during the pandemic. The study was funded by the Centers for Disease Control and Prevention (CDC), the Centers for Medicare & Medicaid Services (CMS), and the National Institutes of Health. 

Researchers used Medicare Fee-for-Service data from CMS and National Death Index data from the CDC to create 2 cohorts of Medicare beneficiaries who had OUD and were at least 18 years of age. The prepandemic cohort consisted of 105,162 beneficiaries with data available from September 2018 to February 2020. The pandemic cohort included 70,479 beneficiaries with data available from September 2019 to February 2021. 

Compared to the prepandemic cohort, the pandemic cohort experienced higher rates of all-cause mortality (99.9 per 1000 beneficiaries, 7041 deaths vs 76.8 per 1000, 8076 deaths [P < .001]) and fatal drug overdoses (5.1 per 1000 beneficiaries, n=358 vs 3.7 per 1000; n=391 [P < .001]).

Individuals in the pandemic cohort had lower adjusted odds (aOR) of experiencing fatal drug overdoses if they received:

• OUD-related telehealth services (aOR, 0.67; 95% CI, 0.48 to 0.92);
• medications from opioid treatment programs (aOR, 0.41; 95% CI, 0.25 to 0.68); or
• buprenorphine in office-based settings (aOR, 0.62; 95% CI, 0.43 to 0.91).

However, receipt of extended-release naltrexone in office-based settings was not associated with lower odds of a fatal overdose (aOR, 1.16; 95% CI, 0.41-3.26).

Researchers concluded there was a reduced risk for fatal drug overdose for Medicare beneficiaries initiating OUD-related care during the COVID-19 pandemic. Despite these results, only 1 in 5 beneficiaries in the pandemic cohort received OUD-related telehealth services, and only 1 in 8 received medications for OUD.²

Based on their findings, researchers recommend continued strategies to increase access to medications for OUD, care retention, and treatment for concurrent health conditions. 

“This study shows that many beneficiaries were able to utilize opioid use disorder-related telehealth services during the pandemic, but we need to continue our efforts to broaden the use of telehealth, particularly in underserved communities,” said Shari Ling, MD, deputy chief medical officer at CMS and first author of the study.²

References:

1. Jones CM, Shoff C, Blanco C, Losby JL, Ling SM, Compton WM. 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. JAMA Psychiatry. Published online March 29, 2023. doi:10.1001/jamapsychiatry.2023.0310

 2. Increased use of telehealth services and medications for opioid use disorder during the COVID-19 pandemic associated with reduced risk for fatal overdose. News release. Centers for Medicare & Medicaid Services. March 29, 2023. Accessed April 3, 2023. https://www.cms.gov/newsroom/press-releases/increased-use-telehealth-services-and-medications-opioid-use-disorder-during-covid-19-pandemic