Since the Covid-19 pandemic, the use of telemedicine has widely proliferated across care settings. However, its novelty means that the efficacy and ideal delivery of remote care require further investigation. In a study on telemedicine’s impact on the treatment of opioid use disorder (OUD) published in the July edition of the Journal of the American Medical Association (JAMA) Health Forum, Williams and colleagues measured the clinical outcomes of an innovative opioid screening and treatment program based in the US.
Over the course of the study, patients receiving telehealth-based opioid treatment (TBOT) exhibited increased retention and adherence to pharmaceutical treatment, as well as decreased detection of opioids in drug screenings. This study offers a timely intervention for the spike in addiction to opioids such as fentanyl and oxycodone, as well as the corresponding increase in opioid-related deaths that have afflicted the US over the past decade. GlobalData epidemiologists forecast an increase in the country’s total prevalent cases of opioid addiction from over 1,958,000 to nearly 2,002,000 cases between 2023 and 2028. Wider implementation of TBOT across the country may lead to a decrease in forecasted prevalent cases as patients receive successful, lasting treatment.
In the first known study of its kind, Williams and colleagues conducted an observational cohort study among OUD patients between January 2021 and December 2022. The study included 3,395 patients from rural and urban settings spanning 14 states. Following an intake visit, participants received a prescription for buprenorphine, a drug commonly administered in OUD treatment, and a set of urine drug screening kits in the mail. Throughout the course of the study, participants sent screening kits to clinicians, who would communicate and conduct appointments with patients exclusively online. Screening kits were analyzed for pharmaceutical adherence and opioid positivity quarterly at 30-, 90-, and 180-day intervals to track treatment plan progress. While a majority of participants adhered to drug screening through the first 90 days, the final cohort was reduced to 1,699 patients by the end of the study at 180 days. Opioid positivity fell from 7.9% to 3.3% during the same timeline.
Screening was also performed for specific opioids, showing a notable drop in fentanyl positivity from 4.3% to 1.7% and a reduction in oxycodone positivity from 2.1% to 1.1%. Based on these results, Williams and colleagues conclude that TBOT appears to be both a feasible and effective method of removing barriers to patient access.
The study conducted by Williams and colleagues bolsters the growing case for expanded administration of telemedicine. The results are particularly promising for patients experiencing substance use disorders, who may perceive frequent screening and social stigma in brick-and-mortar care settings as barriers to care. Moreover, TBOT may overcome the isolation that has obstructed healthcare access in exurban communities, many of which have suffered the most dramatically from opioid addiction’s recent spike. As projected by GlobalData epidemiologists, the opioid epidemic continues to pose a formidable threat to public health in the US. Innovations such as TBOT, if facilitated by strategic policies improving patient access, may clear the path to a coherent plan to mitigate it.