New Research Shows Promise of Telehealth in Treating Opioid Use Disorder

AUG

2020

Gopal Khanna, M.B.A., and

Christine Chang, M.D., M.P.H.

It’s been all-hands-on-deck at AHRQ during the COVID-19 crisis. A national health emergency demands a national response, and AHRQ is proud to join with our sister agencies within the Department of Health and Human Services in contributing where we can. Most recently, this means supporting novel, high-impact studies that evaluate the responsiveness of healthcare delivery systems, healthcare professionals, and the overall U.S. healthcare system to the pandemic.

Yet, as we continue to combat the COVID-19 crisis and study our healthcare system’s response, we must also find safe, effective, and high-quality ways to continue “business as usual” for other healthcare services.

Perhaps the most dramatic transformation to healthcare delivery during the COVID-19 crisis has been rapid expansion and use of telehealth services. During this public health crisis, Medicare has added 135 new virtual telehealth services, expanded the list of eligible providers, and allowed services to be rendered in new settings. This has created a tremendous new body of evidence that requires new research to determine what has worked, and what hasn’t.

As telehealth services have become a more regular and permanent part of the healthcare delivery ecosystem, AHRQ has dramatically expanded its research in this space to help providers address ongoing healthcare needs more safely and effectively during the COVID-19 crisis.

One of the most immediate of those needs is the opioids crisis—a public health epidemic that claims more than 130 lives per day. Opioid Use Disorder (OUD) continues to devastate families and communities, sitting at the center of a drug overdose scourge that claimed nearly 71,000 lives in the United States last year.

There is evidence

that people who receive longer-term treatment with medications for addiction treatment (MAT) have better outcomes. But, keeping people with OUD on MAT is challenging. Now, the COVID-19 pandemic may be making retention of patients in MAT even more difficult.

Fortunately, we can report some good news that should help us fight the opioids epidemic even as we try to maintain safe distance. It appears that people with OUD will stay in treatment when given support remotely as they do in person—a major benefit that appears to be emerging during the COVID pandemic.

This finding comes from a new Rapid Evidence Review on strategies to retain patients in MAT for OUD. The new AHRQ report found that MAT programs that included telehealth fared at least as well as their in-person counterparts in keeping patients in treatment.

Our partners at the Substance Abuse and Mental Health Services Administration define MAT as the “use of medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.” The strategy has shown great promise in treating OUD. The medications are not simply the substitution of one drug for another; rather, it is the evidence-based use of certain medications (methadone, buprenorphine, or naltrexone) to normalize brain chemistry in order to reduce cravings and withdrawal symptoms.

In this new study, researchers from the AHRQ-supported Scientific Resource Center at the Portland (OR) VA Research Foundation

examined evidence on what works to help people stay on MAT. The telehealth finding was one of several compelling conclusions about evidence around MAT.

We are also optimistic about the impact of ongoing efforts by AHRQ grantees to use telehealth and other innovations to help rural primary care practices deliver MAT.

Let’s caution that telehealth is not a magic bullet for all situations. But, these findings comport with those from another recent report from AHRQ’s Effective Health Care Program, which found that telehealth can provide additional specialized staff through remote intensive care units, speed emergency care decisions, and expand access to specialty care. Telehealth also has an added benefit of reducing exposure to COVID-19.

We need to use every successful approach we can to solve the opioid crisis. From AHRQ’s new Rapid Evidence Review and from recent research, we know that MAT saves lives and there are potential ways to keep people in MAT. Now, the next step is implementation and expansion of MAT. (AHRQ resources, such as the MAT for OUD Playbook and a compendium of Tools & Resources, are a good place to start.) We also need more research that focuses specifically on keeping patients enrolled in MAT to provide more definitive and specific information about what works and for whom.

AHRQ’s work to combat the opioid crisis is just one example of why we need to see cure and care as two sides of the same coin when it comes to improving the health and well-being of the American people. As researchers and innovators continue to discover new cures and therapies, AHRQ will continue to produce evidence and best-practices to ensure that these 21st century cures translate to 21st century care.

So much work remains, and AHRQ is excited to contribute to our national efforts now, and in a post-COVID-19 era.

Mr. Khanna is Director of AHRQ. Dr. Chang is a Medical Officer in AHRQ’s Evidence-based Practice Center Program.