Treatment of opioid use disorder during COVID-19: Experiences of clinicians transitioning to telemedicine

https://doi.org/10.1016/j.jsat.2020.108124Get rights and content

Highlights

  • Nearly all participating clinicians were offering telemedicine in the early weeks of the COVID-19 pandemic.

  • Several clinicians waived drug screening, prescribed a larger supply of OUD medications, and/or required fewer visits.

  • Participants noted positive impacts of telemedicine including greater access and convenience for patients.

  • Negative impacts included less structure and accountability and less information to inform clinical decision-making.

Abstract

Objective

The COVID-19 pandemic has transformed care delivery for patients with opioid use disorder (OUD); however, little is known about the experiences of front-line clinicians in the transition to telemedicine. This study described how, in the context of the early stages of the pandemic, clinicians used telemedicine for OUD in conjunction with in-person care, barriers encountered, and implications for quality of care.

Methods

In April 2020, we conducted semistructured interviews with clinicians waivered to prescribe buprenorphine. We used maximum variation sampling. We used standard qualitative analysis techniques, consisting of both inductive and deductive approaches, to identify and characterize themes.

Results

Eighteen clinicians representing 10 states participated. Nearly all interview participants were doing some telemedicine, and more than half were only doing telemedicine visits. Most participants reported changing their typical clinical care patterns to help patients remain at home and minimize exposure to COVID-19. Changes included waiving urine toxicology screening, sending patients home with a larger supply of OUD medications, and requiring fewer visits. Although several participants were serving new patients via telemedicine during the early weeks of the pandemic, others were not. Some clinicians identified positive impacts of telemedicine on the quality of their patient interactions, including increased access for patients. Others noted negative impacts including less structure and accountability, less information to inform clinical decision-making, challenges in establishing a connection, technological challenges, and shorter visits.

Conclusions

In the context of the pandemic, buprenorphine prescribers quickly transitioned to providing telemedicine visits in high volume; nonetheless, there are still many unknowns, including the quality and safety of widespread use of telemedicine for OUD treatment.

Keywords

Telehealth
COVID-19
Telemedicine
Opioid use disorder
Substance use disorder
Telemental health
Tele-OUD

Cited by (0)

This work was supported by a grant from the National Institute on Drug Abuse (R01DA048533-01). Dr. Huskamp was also supported by an additional grant from the National Institute on Drug Abuse (P30 DA035772).

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