Daily Dose: Opioid Use Disorder–Related Telehealth Services, Medications & Risk of Fatal Overdose

Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On March 31, 2023, we reported on a study published in JAMA Psychiatry that examined the association of receipt of telehealth services and medications for opioid use disorder (OUD) with fatal drug overdoses before and during the COVID-19 pandemic.

The study

Investigators compared data from 2 cohorts of Medicare beneficiaries aged ≥18 years with OUD across 2 time periods. The first cohort (prepandemic cohort) was constructed with data from September 2018-February 2020 and included 105 162 beneficiaries (58.1% women, 67.6% aged 45-74 years). The second cohort (pandemic cohort) was constructed with data from September 2019-February 2021 and included 70 479 beneficiaries (57.1% women, 66.3% aged 45-74 years). Also, the researchers conducted an analysis to examine the demographic and clinical characteristics associated with fatal overdose in the pandemic cohort.

A larger percentage of persons in the pandemic cohort received OUD-related telehealth services than those in the prepandemic cohort (13 809 [19.6%] vs 590 [0.6%]; P<.001). Receipt of medications for OUD (MOUD) was higher in the pandemic cohort than in the prepandemic cohort (8826 [12.6%] vs 11 304 [10.8%]; P<.001). Researchers observed a higher rate of all-cause mortality in the pandemic cohort (99.9 per 1000 beneficiaries; 7041 deaths) than in the prepandemic cohort (76.8 per 1000 beneficiaries; 8076 deaths) (P<.001). The rate of fatal drug overdoses was also higher in the pandemic cohort (5.1 per 1000 beneficiaries; n=358) than in the prepandemic cohort (3.7 per 1000 beneficiaries; n=391) (P<.001). The percentage of deaths due to a fatal drug overdose was similar in the prepandemic cohort (4.8%) and pandemic (5.1%) cohort (P=.49).

Note from authors

"This cohort study found that, among Medicare beneficiaries initiating OUD-related care during the COVID-19 pandemic, receipt of OUD-related telehealth services was associated with reduced risk for fatal drug overdose, as was receipt of MOUD from opioid treatment programs and receipt of buprenorphine in office-based settings. Strategies to expand provision of MOUD, increase retention in care, and address co-occurring physical and behavioral health conditions are needed."

Click here for more details.