Factors Associated With Telehealth Buprenorphine Initiation

OBJECTIVE: Telehealth expanded buprenorphine access for opioid use disorder (OUD) after COVID-19 federal flexibilities permitted telehealth initiation. Limited evidence exists comparing telehealth and in-person buprenorphine initiation. This study examines correlates of telehealth versus in-person buprenorphine initiation among adults with OUD. METHODS: We conducted a retrospective, cross-sectional analysis using the Integrated Humana Medical and Pharmacy dataset, including commercial, Medicaid, Medicare Advantage (MAPD), and Medicare Part D prescription drug plans (PDP). Adults with newly diagnosed OUD who initiated buprenorphine between March 17, 2020, and December 31, 2023, with no prior use in the preceding 180 days, were included. Correlates of telehealth initiation were identified using the Least Absolute Shrinkage and Selection Operator-penalized logistic regression. RESULTS: Among 4034 patients, 748 (18.5%) initiated treatment via telehealth and 3286 (81.5%) in-person visits. Telehealth initiation was most common among patients aged 24-35 (25.0%) and least common among those aged 65+ (12.2%). Adjusted analyses found younger age (aOR: 1.54, 95% CI: 1.07-2.21 for ages 24-35 vs. 65+), prior telehealth use (aOR: 1.92, 1.55-2.37), cannabis use disorder (aOR: 1.38, 1.08-1.76), sedative use disorder (aOR: 1.63, 1.22-2.16), psychiatric/behavioral provider type (aOR: 2.38, 1.87-3.04), and zero comorbidities (aOR: 1.76, 1.33-2.34) as positively associated with telehealth initiation. Suburban (aOR: 0.73, 0.58-0.91) and urban (aOR: 0.77, 0.62-0.96) patients were less likely to initiate via telehealth compared with rural patients. CONCLUSIONS: Approximately 1 in 5 patients initiated buprenorphine via telehealth, with significant variation by age, geography, prior telehealth experience, comorbidity burden, and provider speciality. These findings underscore the need for postpandemic policies that preserve telehealth access although maintaining robust in-person treatment options to address diverse patient needs.