Rutgers Study Finds Provider Consensus that Temporary Changes in Opioid Addiction Treatment Should Become Permanent
Researchers found telehealth and loosened restrictions due to COVID-19 removed barriers to treatment
The COVID-19 pandemic prompted swift but temporary changes in regulations for treating opioid use disorder, but treatment providers in New Jersey say many of those changes – which may have improved treatment access and enabled more flexible, individualized patient care – should become permanent, according to a study by the Center for Health Services Research, a unit of the Institute for Health, Health Care Policy and Aging Research at Rutgers University-New Brunswick.
“We wanted to understand the impact of the COVID-19 pandemic with treatment providers in New Jersey, where we’ve been hard hit by both COVID-19 and the opioid crisis,” said lead researcher Peter Treitler, a research specialist at the Center for Health Services Research.
Researchers interviewed 20 New Jersey opioid use disorder treatment providers working in methadone clinics or in office-based settings on the temporary modifications. The study is published in the Journal of Substance Abuse Treatment.
Before the pandemic, people with opioid addictions had to appear at these facilities in-person, often daily, to obtain their medicine and receive counseling and other services. At the onset of COVID-19, federal regulatory agencies rapidly loosened in-person rules, allowing patients more take-home doses of methadone and permitting physicians to prescribe buprenorphine—which helps people reduce or quit their use of heroin or other opiates—via telehealth.
Treitler said providers reported that telehealth removed barriers for many patients by allowing them to connect to care from where they are, especially critical for patients with transportation or child care needs, those who lived far away from their providers or patients with work schedules that made daytime appointments difficult.
“The flexibility of telehealth as it related to patients' employment stability was important for providers because maintaining employment is often an important aspect of recovery,” he said.
The temporary changes also allowed for more prescriptions by mid-level providers, more cross-state prescribing, permission to use video conferencing products and reimbursement structure changes. Other changes included remote evaluations for patients starting buprenorphine and telehealth consultations with reimbursements equal to in-person services.
Providers reported few overdoses happened and that patients were more likely to adhere to treatment, allaying initial concerns that more take-home methadone could increase the risk of overdose. However, a few patients unfamiliar with or unable to access telehealth platforms found it difficult to sustain treatment, while other patients had difficulty finding a private place for telehealth appointments.
Yet, researchers found that providers unanimously support the temporary changes becoming permanent because they allow for more adaptable and tailored patient care that can help maintain access without a decline in care quality.
The study, part of a project funded by a grant from the FORE Foundation, was coauthored by Cadence F. Bowden and James Lloyd of the Rutgers Center for Health Services Research, Michael Enich of the Rutgers Center for Prevention Science at the School of Social Work, Amesika N. Nyaku of Rutgers New Jersey Medical School and Stephen Crystal of the Rutgers Center for Health Services Research and School of Social Work.
