CE24-012 - Evaluating Telehealth's Role in Buprenorphine Treatment Initiation and Retention, Overdose Mortality, and Access Equity: An Analysis for Policy Development

PROJECT SUMMARY/ABSTRACT Sweeping federal and state policy changes in 2020 brought on by the COVID-19 pandemic led to unprecedented access to telehealth care, allowing hundreds of thousands of people with opioid use disorder (OUD) to connect to buprenorphine prescribers from their phone, tablet, or computer. Telehealth is a crucial tool for managing OUD, where timely and consistent access to treatments like buprenorphine can reduce opioid overdoses, which are at historic highs. However, the simultaneous implementation of a wide array of state-level telehealth policies during the 2020 public health emergency (PHE), varying significantly across states, has created a complex landscape. Coupled with the many other policy changes that occurred during 2020, it is challenging to discern which combinations of telehealth policies had the greatest impacts on buprenorphine treatment and opioid overdoses. Our project aims to address this problem. We have three Aims. In Aim 1, we will use controlled interrupted time-series analysis to disentangle the effects of buprenorphine telehealth policies on buprenorphine treatment initiation and retention, non-opioid substance use disorders (as a measure of polysubstance use), and opioid overdoses from the impacts of COVID-19 and the associated PHE, using IQVIA's comprehensive and longitudinal prescription and medical claims data, emergency department and fatal overdose data, and state policy datasets. We will also assess the extent to which any positive impacts differed for people in rural areas, minorities, and low-income individuals. In Aim 2, we will profile states' telehealth policies using state policy datasets, employing latent class analysis to identify unique combinations of telehealth policies that states chose to enact. This categorization will enable us to identify which combinations were most effective in achieving positive health outcomes. In Aim 3, we adopt a systems science approach, collaborating with state public health authorities to create and analyze a causal loop diagram. This systems tool will depict the complex interactions that have developed over time between various factors influencing telehealth policy implementation, including barriers and facilitators, with the goal of informing both state- and national-level telehealth policy development and implementation. Given the end of the COVID-19 PHE and the regulatory changes proposed by the US Drug Enforcement Administration that would limit telehealth buprenorphine treatment initiation, our research is critically timely in influencing long-term telehealth policies. Our interdisciplinary team, with expertise in OUD treatment, telehealth, policy analysis, large-scale data analysis, systems science, and qualitative research, is uniquely positioned to provide insights that could shape future telehealth policies, enhancing access to buprenorphine and saving lives. This project promises to contribute to public health, guiding policy decisions in the ongoing battle against the opioid overdose crisis.