Telemedicine Use and Quality of Opioid Use Disorder Treatment in the US During the COVID-19 Pandemic.

Importance: Little is known about the potential implications of the rapid transition to telehealth during the COVID-19 pandemic for treatment of opioid use disorder (OUD). Objective: To examine the association between telemedicine adoption during the COVID-19 pandemic and indicators of OUD treatment quality. Design, Setting, and Participants: This cohort study analyzed deidentified administrative claims data from OptumLabs Data Warehouse. Claims for telemedicine visits were included for both the prepandemic period (March 14, 2019, to March 13, 2020) and pandemic period (March 14, 2020, to March 13, 2021). Patients with OUD and continuous enrollment in either commercial insurance or Medicare Advantage plans were included. Clinicians who provided office-based OUD care were included and categorized into low, medium, or high telemedicine use groups. Patients were attributed to the clinician (and corresponding telemedicine use group) from whom they received a plurality of OUD visits. Main Outcomes and Measures: The 4 outcomes were all outpatient visits, OUD visits (in person vs telemedicine) within 90 days of an index visit, medications for OUD (MOUD) prescribing, and OUD-related clinical events (including drug overdose, inpatient detoxification and rehabilitation center stay, or injection drug use-related infections). Results: The analysis included 11 801 patients (mean [SD] age, 53.9 [15.7] years; 5902 males [50.0%]) who were treated by 1768 clinicians. Clinicians with low vs high telemedicine use conducted a mean (SD) of 2.1% (2.5%) vs 69.5% (18.6%) of their office visits virtually in the pandemic period. While telemedicine use for OUD increased significantly from the prepandemic to pandemic periods, total OUD visit volume (in person plus telemedicine) per patient episode remained stable among both high (2.6 to 2.7 visits per patient episode) and low (3.1 to 3.3 visits per patient episode) telemedicine use groups. In adjusted analyses comparing the prepandemic with pandemic periods, there was no differential change in MOUD initiation (adjusted odds ratio [OR], 1.00; 95% CI, 0.84-1.19), MOUD days' supply (differential change in days' supply, -0.27; 95% CI, -1.84 to 1.30), or OUD-related clinical events (adjusted OR, 1.01; 95% CI, 0.73-1.24) among patients who were treated by clinicians in low vs high telemedicine use groups. Conclusions and Relevance: Results of this study revealed that clinical outcomes were similar among patients who were treated by clinicians with high and low telemedicine use during the COVID-19 pandemic, suggesting that telemedicine is a comparable alternative to in-person OUD care. There was no evidence that telemedicine was associated with increased access to or improved quality of OUD treatment.