Telehealth for Opioid Use Disorder: One Year Retention during the US COVID-19 Pandemic

Telehealth for Opioid Use Disorder: One Year Retention during the US COVID-19 Pandemic | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Telehealth for Opioid Use Disorder: One Year Retention during the US COVID-19 Pandemic Stephen Martin, Alyson Smith, Nathan Kahn, Stephanie Strong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-1824519/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To determine retention in care for opioid use disorder when treated solely via telehealth with a harm reduction, low-threshold model. Methods: Retrospective cohort analysis of aggregated, anonymized data from 991 patients in telehealth-based buprenorphine treatment. The cohort consisted of patients with commercial or governmental insurance who enrolled between May 17, 2019 andSeptember 28, 2021. Analysis was extended to a maximum of one year for each patient. Results: At one year, retention in care was 55% overall. When analyzed separately, retention at one year was 62% for patients with commercial insurance and 53% for those with governmental insurance. Conclusions: Telehealth-based treatment of opioid use disorder can achieve retention in care for patients—with governmental or commercial insurance—that is superior to inperson treatment as usual. Policy implications: Telehealth for opioid use disorder can be effective for patients over a range of incomes. Regulatory action allowing telehealth-only care Opioid use disorder Medications for opioid use disorder Health care quality Telehealth Health care policy Figures Figure 1 Figure 2 Introduction The American syndemic of opioid use disorder (OUD) and COVID-19 is resulting in record overdose deaths. 1 , 2 Despite the hope of readily-available, life-saving buprenorphine treatment for nearly twenty years, it was already scarce before 2020. Pandemic-induced regulatory action in March 2020 that expanded access to telehealth has created an unprecedented opportunity to meet people’s needs. Existing telehealth findings are promising but conditional on a relationship with a physical site, a single payer system, or an academic locus. 3 , 4 Prior to this recent regulatory action, it was impossible to study telehealth-exclusive buprenorphine care for people in different localities with varied insurance coverage. Boulder Care is a Joint Commission-accredited provider of telehealth care for OUD. We began treating patients in 2019 and were uniquely prepared with clinical infrastructure before COVID-19. Our data allow us to examine the patient-centered outcome of retention in care across a diverse population. Most retention analyses use 180 days as a quality threshold, but since improved mortality can require at least one year of treatment, 5 we extended our analysis to this duration. Methods In a retrospective cohort analysis, we examined aggregated, anonymized data from 991 patients with commercial and governmental insurance in telehealth-based buprenorphine treatment. Like other practices, we allow up to 90 days between clinical visits for stable patients. 90 days without clinical contact—plus 15 days to reschedule—must elapse before patients are considered “unretained” as of their last clinical touchpoint. We considered patients “retained” when they maintained clinical contact, and “unretained” when patients explicitly discontinued and unenrolled or exceeded 105 days since their last clinical contact. Boulder Care provides the same services to all patients irrespective of insurance type. We defined government payors as Medicaid and Medicare. Commercial payors were the remaining forms of private insurance. The study design was reviewed by the UMass Chan Medical School Institutional Review Board. The Board determined the activity was not research involving human subjects and its review was not required. Results Our cohort consisted of 991 patients who enrolled between May 17, 2019 and September 28, 2021. 899 enrolled after March 2020 changes in telehealth regulation. Figure 1 presents our retention over 365 days and the national average, 29%, at 180 days. 6 82.7% of our insured patients have government coverage (78.3% Medicaid and 4.4% Medicare) and 17.3% have commercial coverage. Figure 2 presents retention by insurance type. The differences at 30, 90 and 180 days were statistically significant (p 30 < 0.001, p 90 < 0.001, p 180 < 0.001). Conclusion This retrospective cohort analysis of telehealth care for OUD demonstrates retention levels that are superior to usual treatment. Research using pharmacy-level data has found national retention levels of 29% at 180 days. 6 Patients with both commercial and government insurance were retained at higher rates, suggesting efficacy across diverse patient backgrounds. The data show somewhat lower retention for people with Medicaid, with a maximum absolute difference of 17.7% at 200 days. Limitations of our study include the provider-specific nature of these results. Boulder Care’s model is built on low-threshold principles and other evidence-based supports in addition to buprenorphine prescribing, including Peer Recovery Specialists and Care Management. Consistent with a harm reduction, non-punitive approach, patients are not discharged for missed visits or ongoing substance use. 4 Telehealth models with different approaches may not have comparable retention rates. The present study provides reassurance that telehealth-based care is not only effective, it can also allow patients with either governmental or commercial insurance a retention rate superior to in-person care. We must now find ways to fully achieve equity for patients no matter their demographics. To do so, legislative and regulatory changes must be made permanent, allowing this improved access and quality of care for OUD—both of which are desperately needed—to continue via telehealth. 2 Abbreviations OUD Opioid Use Disorder Declarations Ethics approval and consent to participate The study design was reviewed by the UMass Chan Medical School Institutional Review Board. The Board determined the activity was not research involving human subjects and its review was not required. Consent for publication Not applicable. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests SM reported being an employee for Boulder Care. AS reported being an employee of Boulder Care. NK reported being an employee of Boulder Care. SS reported being an employee of and shareholder in Boulder Care. Funding This analysis was funded by Boulder Care. As employees of Boulder Care, the authors directed the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Authors' contributions All listed authors have made substantial contributions to the manuscript and have approved the submitted version. SM: Conception and design of work, interpretation of data, writing and substantial revisions of manuscript. AS: Interpretation of data and substantial revisions of manuscript. NK: Conception and design of work, acquisition/analysis and interpretation of data, writing and substantial revisions of manuscript. SS: Interpretation of data and substantial revisions of manuscript. Acknowledgements Not applicable. Authors' information (optional) SM is also an Associate Professor of Family Medicine and Community Health at UMass Chan Medical School. References O’Donnell J, Tanz LJ, Gladden RM, Davis NL, Bitting J. Trends in and Characteristics of Drug Overdose Deaths Involving Illicitly Manufactured Fentanyls - United States, 2019–2020. MMWR Morb Mortal Wkly Rep. 2021;70(50):1740–1746. doi: 10.15585/mmwr.mm7050e3 Davis CS, Samuels EA. Continuing increased access to buprenorphine in the United States via telemedicine after COVID-19. Int J Drug Policy. 2021;93:102905. doi: 10.1016/j.drugpo.2020.102905 Guillen AG, Reddy M, Saadat S, Chakravarthy B. Utilization of Telehealth Solutions for Patients with Opioid Use Disorder Using Buprenorphine: A Scoping Review. Telemed J E Health. Published online October 29, 2021. doi: 10.1089/tmj.2021.0308 Samuels EA, Khatri UG, Snyder H, Wightman RS, Tofighi B, Krawczyk N. Buprenorphine Telehealth Treatment Initiation and Follow-Up During COVID-19. J Gen Intern Med . Published online January 3, 2022. doi: 10.1007/s11606-021-07249-8 Cornish R, Macleod J, Strang J, Vickerman P, Hickman M. Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database. BMJ. 2010;341:c5475. doi: 10.1136/bmj.c5475 Olfson M, Zhang V, Schoenbaum M, King M. Buprenorphine Treatment by Primary Care Providers, Psychiatrists, Addiction Specialists, and Others. Health Aff. 2020;39(6):984–992. doi: 10.1377/hlthaff.2019.01622 Additional Declarations Competing interest reported. SM reported being an employee for Boulder Care. AS reported being an employee of Boulder Care. NK reported being an employee of Boulder Care. SS reported being an employee of and shareholder in Boulder Care. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-1824519","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Short Report","associatedPublications":[],"authors":[{"id":119318531,"identity":"c3d8ba90-4622-40b2-a78a-b557a4a7eb19","order_by":0,"name":"Stephen Martin","email":"data:image/png;base64,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","orcid":"","institution":"Boulder Care","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Stephen","middleName":"","lastName":"Martin","suffix":""},{"id":119318532,"identity":"d58f2cda-b596-4c37-a99f-a676b7161ca3","order_by":1,"name":"Alyson Smith","email":"","orcid":"","institution":"Boulder Care","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Alyson","middleName":"","lastName":"Smith","suffix":""},{"id":119318533,"identity":"805815be-a43d-4126-a1dc-2b50bb0a6b55","order_by":2,"name":"Nathan Kahn","email":"","orcid":"","institution":"Boulder Care","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Nathan","middleName":"","lastName":"Kahn","suffix":""},{"id":119318534,"identity":"f4048707-34f3-4633-bce1-bbd6d2925fbd","order_by":3,"name":"Stephanie Strong","email":"","orcid":"","institution":"Boulder Care","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Stephanie","middleName":"","lastName":"Strong","suffix":""}],"badges":[],"createdAt":"2022-07-04 15:59:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-1824519/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-1824519/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":23587970,"identity":"69961ba2-1a7d-49f1-a512-ac7315169260","added_by":"auto","created_at":"2022-07-07 15:43:13","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":42771,"visible":true,"origin":"","legend":"\u003cp\u003eRetention of Cohort Patients\u0026nbsp;\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-1824519/v1/b2fa6ecf221e430efbdf4912.jpeg"},{"id":23587971,"identity":"67618580-9b8f-4951-8b9f-704b201e0b61","added_by":"auto","created_at":"2022-07-07 15:43:13","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":52459,"visible":true,"origin":"","legend":"\u003cp\u003eCohort Retention by Payer Type\u003c/p\u003e\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-1824519/v1/e6b4526fe15f23a0b7b619e6.jpeg"},{"id":25157542,"identity":"ec930eec-9a8b-47d4-982b-f6fe76f925cc","added_by":"auto","created_at":"2022-08-12 19:44:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":251300,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-1824519/v1/0d81b8e5-6cbe-4419-9873-3baa9ece38c4.pdf"}],"financialInterests":"Competing interest reported. SM reported being an employee for Boulder Care. AS reported being an employee of Boulder Care. NK reported being an employee of Boulder Care. SS reported being an employee of and shareholder in Boulder Care.","formattedTitle":"Telehealth for Opioid Use Disorder: One Year Retention during the US COVID-19 Pandemic","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe American syndemic of opioid use disorder (OUD) and COVID-19 is resulting in record overdose deaths.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Despite the hope of readily-available, life-saving buprenorphine treatment for nearly twenty years, it was already scarce before 2020. Pandemic-induced regulatory action in March 2020 that expanded access to telehealth has created an unprecedented opportunity to meet people\u0026rsquo;s needs.\u003c/p\u003e \u003cp\u003eExisting telehealth findings are promising but conditional on a relationship with a physical site, a single payer system, or an academic locus.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Prior to this recent regulatory action, it was impossible to study telehealth-exclusive buprenorphine care for people in different localities with varied insurance coverage.\u003c/p\u003e \u003cp\u003eBoulder Care is a Joint Commission-accredited provider of telehealth care for OUD. We began treating patients in 2019 and were uniquely prepared with clinical infrastructure before COVID-19. Our data allow us to examine the patient-centered outcome of retention in care across a diverse population. Most retention analyses use 180 days as a quality threshold, but since improved mortality can require at least one year of treatment,\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e we extended our analysis to this duration.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eIn a retrospective cohort analysis, we examined aggregated, anonymized data from 991 patients with commercial and governmental insurance in telehealth-based buprenorphine treatment.\u003c/p\u003e \u003cp\u003eLike other practices, we allow up to 90 days between clinical visits for stable patients. 90 days without clinical contact\u0026mdash;plus 15 days to reschedule\u0026mdash;must elapse before patients are considered \u0026ldquo;unretained\u0026rdquo; as of their last clinical touchpoint. We considered patients \u0026ldquo;retained\u0026rdquo; when they maintained clinical contact, and \u0026ldquo;unretained\u0026rdquo; when patients explicitly discontinued and unenrolled or exceeded 105 days since their last clinical contact.\u003c/p\u003e \u003cp\u003eBoulder Care provides the same services to all patients irrespective of insurance type. We defined government payors as Medicaid and Medicare. Commercial payors were the remaining forms of private insurance.\u003c/p\u003e \u003cp\u003e The study design was reviewed by the UMass Chan Medical School Institutional Review Board. The Board determined the activity was not research involving human subjects and its review was not required.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eOur cohort consisted of 991 patients who enrolled between May 17, 2019 and September 28, 2021. 899 enrolled after March 2020 changes in telehealth regulation. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents our retention over 365 days and the national average, 29%, at 180 days.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e82.7% of our insured patients have government coverage (78.3% Medicaid and 4.4% Medicare) and 17.3% have commercial coverage. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents retention by insurance type. The differences at 30, 90 and 180 days were statistically significant (p\u003csub\u003e30\u003c/sub\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, p\u003csub\u003e90\u003c/sub\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001, p\u003csub\u003e180\u003c/sub\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis retrospective cohort analysis of telehealth care for OUD demonstrates retention levels that are superior to usual treatment. Research using pharmacy-level data has found national retention levels of 29% at 180 days.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Patients with both commercial and government insurance were retained at higher rates, suggesting efficacy across diverse patient backgrounds. The data show somewhat lower retention for people with Medicaid, with a maximum absolute difference of 17.7% at 200 days.\u003c/p\u003e \u003cp\u003eLimitations of our study include the provider-specific nature of these results. Boulder Care\u0026rsquo;s model is built on low-threshold principles and other evidence-based supports in addition to buprenorphine prescribing, including Peer Recovery Specialists and Care Management. Consistent with a harm reduction, non-punitive approach, patients are not discharged for missed visits or ongoing substance use.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Telehealth models with different approaches may not have comparable retention rates.\u003c/p\u003e \u003cp\u003eThe present study provides reassurance that telehealth-based care is not only effective, it can also allow patients with either governmental or commercial insurance a retention rate superior to in-person care. We must now find ways to fully achieve equity for patients no matter their demographics. To do so, legislative and regulatory changes must be made permanent, allowing this improved access and quality of care for OUD\u0026mdash;both of which are desperately needed\u0026mdash;to continue via telehealth.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eOUD \u0026nbsp; \u0026nbsp;Opioid Use Disorder\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study design was reviewed by the UMass Chan Medical School Institutional Review Board. The Board determined the activity was not research involving human subjects and its review was not required.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSM reported being an employee for Boulder Care. AS reported being an employee of Boulder Care. NK reported being an employee of Boulder Care. SS reported being an employee of and shareholder in Boulder Care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis analysis was funded by Boulder Care. As employees of Boulder Care, the authors directed the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll listed authors have made substantial contributions to the manuscript and have approved the submitted version. SM: Conception and design of work, interpretation of data, writing and substantial revisions of manuscript. AS: Interpretation of data and substantial revisions of manuscript. NK: Conception and design of work, acquisition/analysis and interpretation of data, writing and substantial revisions of manuscript. SS: Interpretation of data and substantial revisions of manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; information (optional)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSM is also an Associate Professor of Family Medicine and Community Health at UMass Chan Medical School.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eO\u0026rsquo;Donnell J, Tanz LJ, Gladden RM, Davis NL, Bitting J. Trends in and Characteristics of Drug Overdose Deaths Involving Illicitly Manufactured Fentanyls - United States, 2019\u0026ndash;2020. MMWR Morb Mortal Wkly Rep. 2021;70(50):1740\u0026ndash;1746. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.15585/mmwr.mm7050e3\u003c/span\u003e\u003cspan address=\"10.15585/mmwr.mm7050e3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavis CS, Samuels EA. Continuing increased access to buprenorphine in the United States via telemedicine after COVID-19. Int J Drug Policy. 2021;93:102905. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.drugpo.2020.102905\u003c/span\u003e\u003cspan address=\"10.1016/j.drugpo.2020.102905\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuillen AG, Reddy M, Saadat S, Chakravarthy B. Utilization of Telehealth Solutions for Patients with Opioid Use Disorder Using Buprenorphine: A Scoping Review. Telemed J E Health. Published online October 29, 2021. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1089/tmj.2021.0308\u003c/span\u003e\u003cspan address=\"10.1089/tmj.2021.0308\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSamuels EA, Khatri UG, Snyder H, Wightman RS, Tofighi B, Krawczyk N. Buprenorphine Telehealth Treatment Initiation and Follow-Up During COVID-19. \u003cem\u003eJ Gen Intern Med\u003c/em\u003e. Published online January 3, 2022. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11606-021-07249-8\u003c/span\u003e\u003cspan address=\"10.1007/s11606-021-07249-8\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCornish R, Macleod J, Strang J, Vickerman P, Hickman M. Risk of death during and after opiate substitution treatment in primary care: prospective observational study in UK General Practice Research Database. BMJ. 2010;341:c5475. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmj.c5475\u003c/span\u003e\u003cspan address=\"10.1136/bmj.c5475\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOlfson M, Zhang V, Schoenbaum M, King M. Buprenorphine Treatment by Primary Care Providers, Psychiatrists, Addiction Specialists, and Others. Health Aff. 2020;39(6):984\u0026ndash;992. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1377/hlthaff.2019.01622\u003c/span\u003e\u003cspan address=\"10.1377/hlthaff.2019.01622\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Opioid use disorder, Medications for opioid use disorder, Health care quality, Telehealth, Health care policy","lastPublishedDoi":"10.21203/rs.3.rs-1824519/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-1824519/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"Objective: To determine retention in care for opioid use disorder when treated solely via telehealth with a harm reduction, low-threshold model.\nMethods: Retrospective cohort analysis of aggregated, anonymized data from 991 patients in telehealth-based buprenorphine treatment. The cohort consisted of patients with commercial or governmental insurance who enrolled between May 17, 2019 andSeptember 28, 2021. Analysis was extended to a maximum of one year for each patient.\nResults: At one year, retention in care was 55% overall. When analyzed separately, retention at one year was 62% for patients with commercial insurance and 53% for those with governmental insurance.\nConclusions: Telehealth-based treatment of opioid use disorder can achieve retention in care for patients—with governmental or commercial insurance—that is superior to inperson treatment as usual.\nPolicy implications: Telehealth for opioid use disorder can be effective for patients over a range of incomes. Regulatory action allowing telehealth-only care","manuscriptTitle":"Telehealth for Opioid Use Disorder: One Year Retention during the US COVID-19 Pandemic","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-07-07 15:43:11","doi":"10.21203/rs.3.rs-1824519/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e9a32d78-c93e-4833-9e2d-f58188ed99cf","owner":[],"postedDate":"July 7th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2022-08-12T19:44:08+00:00","versionOfRecord":[],"versionCreatedAt":"2022-07-07 15:43:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-1824519","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-1824519","identity":"rs-1824519","version":["v1"]},"buildId":"7rjqhiLT3MXkJMwkYKINL","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}