(84) On-Demand, Audio-Only Buprenorphine Initiation During COVID-19

Introduction:
Between May 2020 and April 2021 opioid overdose deaths in the US surged with more than 100,000 people dying from an overdose (CDC 2021). Medications for opioid use disorder (MOUD) substantially reduce mortality and overdose (Santo 2021) but remain underutilized with fewer than 35% of people with opioid use disorder (OUD) engaged in treatment (Jones 2019). Before the COVID-19 pandemic, federal regulations required in-person evaluation for buprenorphine initiation. At the onset of the pandemic, temporary allowances were enacted to enable buprenorphine initiation by telehealth. Audiovisual telehealth has been shown to be as effective as in-person care for buprenorphine maintenance treatment (Zheng 2017, Lin 2019), however, few studies have examined patient follow-up after audio-only buprenorphine treatment initiation. Under these allowances, the Rhode Island Buprenorphine Hotline, a free, on-demand, audio-only, 24-hour telehealth service for buprenorphine initiation, was launched. Here, we describe the characteristics of Rhode Island Buprenorphine Hotline patients and 30-day treatment follow-up in the first year of operation.

Methods:
All patients who consented to treatment via the Buprenorphine Hotline from April 2020 to February 2021 were enrolled in a retrospective cohort study. We obtained patient demographics, substance use history, withdrawal symptoms, and 30-day treatment engagement by reviewing electronic health records and the hotline’s administrative database. Using data from the Rhode Island Prescription Drug Monitoring Program (PDMP), we tracked subsequent buprenorphine prescriptions filled within 30-days of the initial telehealth encounter.

Results:
In total, the hotline received 134 calls between April 1, 2020 and February 28, 2021. Of these callers, 128 were connected to a prescriber for evaluation. Buprenorphine was prescribed in 103 encounters (80.5%, 103/128), and 92 (89.3%, 92/103) of these were new callers who filled their prescriptions within 30 days. Among individuals who filled their prescriptions, most were male (62%, 57/92) and identified as White (69.6%). Two-thirds had previously been in addiction treatment (66.3%, 61/92), but a minority were in treatment at the time of the call (7.6%, 7/92). Most callers who filled their prescriptions had previously taken buprenorphine, including prescribed (45.6%, 42/92) and non-prescribed (63%, 58/92). Most individuals previously prescribed buprenorphine had filled a prescription in the year preceding their call (73.8%, 31/42). Two-thirds of individuals who filled their prescriptions were in opioid withdrawal at the time of the call (66.3%, 61/92) with a mean Subjective Opioid Withdrawal Scale of 26.2 (range 4-57). Over 70% filled a subsequent prescription for buprenorphine within 30-days of the end of their hotline prescription (70.7%, 65/92), on average 5.9 days (range 0-28) after completion of their prescription.

Conclusions:
Telehealth for buprenorphine treatment delivery has rapidly expanded in response to changes in the regulatory environment and treatment access during the COVID-19 pandemic. Our findings show that over 70% of patients who filled their initial prescription after buprenorphine initiation via an audio-only encounter connect to follow-up treatment. The expansion of telehealth-delivered buprenorphine care has the potential to address treatment gaps and facilitate the delivery of on-demand services to patients when they are most motivated. Further research is needed to evaluate treatment outcomes for buprenorphine initiation via telehealth as compared to in-person care.

References: 1. CDC: Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2021. Accessed July 24, 2021. https://wonder.cdc.gov
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