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Buprenorphine induction via telemedicine during the pandemic

Patients commencing buprenorphine treatment for opioid use disorder (OUD) via telemedicine differ from those commencing in person only in being somewhat younger and financially better off, according to a new study. 

When the Drug Enforcement Agency temporarily lifted the in-person evaluation requirement for new buprenorphine prescriptions, to accommodate pandemic social distancing, there was concern that it would be disproportionately used by patients with more severe OUD. To test that hypothesis, researchers examined deidentified commercial and Medicare Advantage claims data for buprenorphine inductions from January 1, 2020, to April 30, 2021, comparing patient characteristics of those receiving telemedicine versus in-person inductions.

Of the 2,703 patients who received a buprenorphine induction during the pandemic (defined as commencing April 1, 2020), 13.9% were via telemedicine. 

“We found no statistically significant differences between patients receiving telemedicine inductions vs in-person inductions in clinical severity and/or complexity markers, nor in whether they had a visit with the induction provider before the induction,” the authors wrote. They did find fewer telemedicine inductions in older individuals and in those from low-income counties.

“Our results may allay concerns stated by the DEA that relaxing the in-person evaluation requirement of the Ryan Haight Act may increase buprenorphine diversion.” The expansion of access to treatment, which telemedicine may provide, “is crucial if we want to maximize pathways of care for patients with OUD, particularly given the ongoing opioid crisis.”

Barsky BA, Busch AB, Patel SY, et al. Use of Telemedicine for buprenorphine inductions in patients with commercial insurance or Medicare advantage. JAMA Netw Open. 2022 Jan 4; 5(1): e2142531.

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