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Comparing telemedicine to in-person buprenorphine treatment in U.S. veterans with opioid use disorder.
Lin, Lewei A; Fortney, John C; Bohnert, Amy S B; Coughlin, Lara N; Zhang, Lan; Piette, John D.
  • Lin LA; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; University of Michigan Injury Prevention Center, Ann Arbor, MI, USA; Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA. Electronic address: leweil@med.umich.edu
  • Fortney JC; Department of Psychiatry, School of Medicine, University of Washington, Seattle, WA, USA; Department of Veterans Affairs, Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, USA.
  • Bohnert ASB; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Anesthesiology, University of Michigan, Ann Arbor, MI, USA.
  • Coughlin LN; Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
  • Zhang L; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
  • Piette JD; VA Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Department of Health Behavior Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
J Subst Abuse Treat ; 133: 108492, 2022 02.
Article in English | MEDLINE | ID: covidwho-1253265
ABSTRACT

BACKGROUND:

Telemedicine-delivered buprenorphine (tele-buprenorphine) can potentially increase access to buprenorphine for patients with opioid use disorder (OUD), especially during the COVID-19 pandemic, but we know little about use in clinical care.

METHODS:

This study was a retrospective national cohort study of veterans diagnosed with opioid use disorder (OUD) receiving buprenorphine treatment from the Veterans Health Administration (VHA) in fiscal years 2012-2019. The study examined trends in use of tele-buprenorphine and compared demographic and clinical characteristics in patients who received tele-buprenorphine versus those who received in-person treatment only.

RESULTS:

Utilization of tele-buprenorphine increased from 2.29% of buprenorphine patients in FY2012 (n = 187) to 7.96% (n = 1352) in FY2019 in VHA veterans nationally. Compared to patients receiving only in-person care, tele-buprenorphine patients were less likely to be male (AOR = 0.85, 95% CI 0.73-0.98) or Black (AOR = 0.54, 95% CI 0.45-0.65). Tele-buprenorphine patients were more likely to be treated in community-based outpatient clinics rather than large medical centers (AOR = 2.91, 95% CI 2.67-3.17) and to live in rural areas (AOR = 2.12, 95% CI1.92-2.35). The median days supplied of buprenorphine treatment was 722 (interquartile range 322-1459) among the tele-buprenorphine patients compared to 295 (interquartile range 67-854) among patients who received treatment in-person.

CONCLUSIONS:

Use of telemedicine to deliver buprenorphine treatment in VHA increased 3.5-fold between 2012 and 2019, though overall use remained low prior to COVID-19. Tele-buprenorphine is a promising modality especially when treatment access is limited. However, we must continue to understand how practitioners and patient are using telemedicine and how these patients' outcomes compare to those using in-person care.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Veterans / Buprenorphine / Telemedicine / COVID-19 / Opioid-Related Disorders Type of study: Etiology study / Incidence study / Observational study / Risk factors Limits: Humans / Male Language: English Journal: J Subst Abuse Treat Journal subject: Substance-Related Disorders Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Veterans / Buprenorphine / Telemedicine / COVID-19 / Opioid-Related Disorders Type of study: Etiology study / Incidence study / Observational study / Risk factors Limits: Humans / Male Language: English Journal: J Subst Abuse Treat Journal subject: Substance-Related Disorders Year: 2022 Document Type: Article