Midwestern changes in substance use and treatment during the COVID-19 pandemic

The SAR-CoV-2 pandemic has contributed to widespread health and healthcare policy changes, including that surrounding substance use disorders. Early indicators suggest that substance use may be increasing, but healthcare policy changes may help counter this increase. Restrictions on telehealth use for the treatment of substance use disorders and the dispensing of drugs to treat opioid use disorder have been eased. This change may be particularly helpful in rural areas where local providers are sparse. The current proposal will investigate changes in substance use and evaluate telehealth's use and effectiveness for the treatment of substance use disorders while exploring the role of rural or urban locations in these trends. The proposed studies will be accomplished through three aims. In the first aim, electronic medical records will be queried to identify patients with alcohol, opioid, or stimulant use disorder or overdoses during the time period encompassing March 2019-April 2021 in the Midwest. Demographic variables, economic variables, and USDA rural/urban classification will be included in the analysis. This aim will help determine trends in drug use measures across the rural/urban spectrum during a period of dynamic change. In the second aim, the use and effectiveness of telehealth for the treatment of substance use disorders will be evaluated. Given the proximity to providers is often cited as barriers to substance use treatment in rural locations, this aim will evaluate the effectiveness of telehealth across the rural/urban continuum. In the third aim, changes in buprenorphine treatment for opioid use disorder will be investigated. Given the sparsity of licensed buprenorphine providers in the rural Midwest, this aim will also examine the use and effectiveness of telehealth for delivering buprenorphine treatment in underserved counties. The resulting findings will provide a better understanding of substance use disorders across the urban and rural continuum while providing critical information to guide healthcare policies related to telehealth usage to treat substance use disorders. The resulting findings will be crucial in developing precision medicine to treat substance use disorder in urban and rural locations.