Telemedicine and increased retention in medications for opioid use disorder treatment

BACKGROUND: Buprenorphine is an effective treatment for Opioid Use Disorder (OUD), but many patients discontinue this medication within six-months of initiation and racial disparities in access and retention in buprenorphine treatment exist. Telemedicine is a potentially promising strategy to improve buprenorphine treatment retention. OBJECTIVE: To determine if, compared to pre-pandemic in-person services, telemedicine visits were associated with increased retention in MOUD treatment at six-months and if there were differences by race. METHODS: This is a retrospective cohort study that evaluated medical records of individuals treated for OUD in-person (n = 247) and via telemedicine (n = 204) at a large academic medical center in the Southeastern United States from 2018 to 2021. The primary outcome was the percentage of patients retained in treatment at six-months, defined as having an outpatient visit associated with a buprenorphine prescription. Chi-squared tests were used to evaluate the percentage of patients retained in treatment at six-months, multivariable logistic regression identified correlates of retention, and Kaplan-Meier survival analyses evaluated time in treatment. RESULTS: =38; 64% female; 89% White; 39% Medicaid insured) were retained in treatment within six-months of their index visit. Individuals with telemedicine-based treatment were 1.8 times more likely to be retained in treatment at six-months compared to those with in-person visits (AOR = 1.87, 95% CI = 1.17-3.00). Non-White individuals were 2.05 times more likely to remain in treatment at six-months, compared to White individuals (AOR = 2.05, 95% CI = 1.02-4.14). CONCLUSION: This study suggests that retention in treatment may be higher with telemedicine-based buprenorphine treatment compared to in-person care. Non-White patients appeared to experience an even greater benefit, though further research is needed to confirm this finding. As policymakers are determining telehealth prescribing laws, these findings further support the use of telemedicine to improve retention in effective treatment.