REMOTE: tREatMent for Opioid use via TElemedicine

PROJECT SUMMARY The opioid epidemic is escalating during the coronavirus disease 2019 (COVID-19) pandemic. During 2018, drug overdoses resulted in 67,367 deaths, with almost 70% involving an opioid. Preliminary data from 2019 show a rise of 4.8% in overdoses from 2018 and with the exacerbations of the COVID-19 pandemic, many states are reporting further increases in opioid-related mortality in 2020. This is likely due to increased social and economic stressors, as well as to limited treatment access, particularly among our most vulnerable populations. Opioid use disorder (OUD) treatment has historically been delivered in person, as federal regulations prohibited prescribing of buprenorphine via telemedicine (e.g., video or telephone) and remote visits were rarely covered by insurance providers. During the pandemic, many insurers began covering telemedicine visits and the federal government exercised authority to allow for the comprehensive treatment of OUD via telemedicine. The option for telemedicine visits could increase OUD treatment accessibility and engagement, particularly among those living in rural areas or whose resources are limited; however, limited research exists on the impact of telemedicine on OUD treatment in primary care settings. We leverage this unprecedented opportunity to study the impact of telemedicine on OUD treatment in primary care settings. Study clinics include two Family Medicine clinics with established OUD treatment programs. These clinics (one rural health center and one federally-qualified health center) serve patients that often face barriers to healthcare access; thus, these are priority populations to study. The aims of this sequential explanatory mixed methods study are as follows: Aim 1: Use electronic health record data to examine telemedicine versus face- to-face visits for OUD-related treatment (e.g., diagnosis, visits with medical provider, behavioral health visits, medication orders, appointment no shows, urine drug screens) before, during, and after implementation of telemedicine; Aim 2: Conduct semi-structured qualitative interviews to assess how patients and clinical team members experience OUD treatment that is delivered via telemedicine modalities. We use qualitative data to further explain the patterns of treatment access and engagement observed in Aim 1 analyses. These findings will inform best practices for remote OUD treatment delivery, whether for long-term sustainability post- pandemic or in response to future emergency situations when in-person visits are not possible. Our findings also lay the foundation for a randomized implementation and effectiveness trial designed to advance access to treatment of OUD among those most in need. This study is highly responsive to the National Institute on Drug Abuse (NIDA)'s Notice of Special Interest (NOSI) in the utilization of telemedicine to develop and support treatments for substance use disorder among patients with or at risk of limitations of mobility (e.g., rural and low SES populations).