Adaptations to Opioid Use Disorder Care During the COVID-19 Pandemic: A National Survey of Prescribers
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Minhee L Sung1, Anne C Black, Derek Blevins
1From the VA Health Services Research & Development, West Haven, CT (MLS); VA Connecticut Healthcare System, West Haven, CT (MLS, ACB, WCB); Yale School of Medicine, New Haven, CT (MLS, ACB, WCB, EJE); Columbia University Vagelos College of Physicians and Surgeons; New York State Psychiatric Institute, Division on Substance Use Disorders, New York City, NY (DB, FRL); School of Social Work, Columbia University, New York, NY (BFH); College of Education, Pennsylvania State University, University Park, PA (BFH); American Academy of Addiction Psychiatry, East Providence, RI (KC-W); Boston University Medical Center, Boston, MA (MAD); Emory University, Atlanta, GA (KD); Addiction Technology Transfer Center Network Coordinating Office, University of Missouri, Kansas City, Kansas City, MO(HH); Center for Health Enhancement Systems Studies, University of Wisconsin, Madison WI (TM); Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT (EJE).
Objectives:
Among opioid use disorder (OUD)-treating providers, to characterize adaptations used to provide medications for OUD (MOUD) and factors associated with desire to continue virtual visits post-COVID-19 pandemic.
Methods:
In a national electronic survey of OUD-treating prescribers (July-August 2020), analyses restricted to X-waivered buprenorphine prescribers providing outpatient, longitudinal care for adults with OUD, quantitative and qualitative analyses of survey items and free text responses were conducted.
Results:
Among 797 respondents, 49% were men, 57% ≥50 years, 76% White, 68% physicians. Respondents widely used virtual visits to continue prescribing existing MOUD regimens (79%), provide behavioral healthcare (71%), and initiate new MOUD prescriptions (49%). Most prescribers preferred to continue/expand use of virtual visits after COVID-19. In multivariable models, factors associated with preference to continue/expand virtual visits to initiate MOUD postpandemic were treating a moderate number of patients prepandemic (aOR = 1.67; 95%[CI] = 1.06,2.62) and practicing in an urban setting (aOR = 2.17; 95%[CI] = 1.48,3.18). Prescribing buprenorphine prepandemic (aOR = 2.06; 95%[CI] = 1.11,3.82) and working in an academic medical center (aOR = 2.47; 95%[CI] = 1.30,4.68) were associated with preference to continue/expand use of virtual visits to continue MOUD postpandemic. Prescribing naltrexone extended-release injection prepandemic was associated with preference to continue/expand virtual visits to initiate and continue MOUD (aOR = 1.51; 95%[CI] = 1.10,2.07; aOR = 1.74; 95%[CI] = 1.19,2.54). Qualitative findings suggest that providers appreciated virtual visits due to convenience and patient accessibility, but were concerned about liability and technological barriers.
Conclusions:
Surveyed prescribers widely used virtual visits to provide MOUD with overall positive experiences. Future studies should evaluate the impact of virtual visits on MOUD access and retention and clinical outcomes.
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