Association Between Telehealth Initiation Of Stimulant Therapy And New Substance Use Disorder Diagnoses

Policy makers have temporarily extended COVID-19 pandemic-related flexibilities allowing controlled substance prescribing via telehealth without in-person visits. To inform debates regarding whether these flexibilities should be permanent, we used commercial and Medicaid claims to evaluate the risk for newly diagnosed substance use disorders (SUDs) associated with telehealth versus in-person initiation of stimulant therapy. Analyses included 77,153 patients ages 12-64 without prior SUD diagnoses who initiated stimulant therapy during 2021. The outcome was a new diagnosis for SUD within 365 days of initiation. The prevalence of new SUDs was higher in the telehealth versus in-person group (3.7 percent versus 3.2 percent), as was the prevalence of psychiatric comorbidities, which are known SUD risk factors. In adjusted analyses, telehealth initiation was not an independent risk factor for new SUDs, as the higher risk for this diagnosis disappeared when we controlled for psychiatric comorbidities. The same was true when we stratified the analyses by age, except among people ages 26-34. These findings suggest that extending telehealth flexibilities for stimulant prescribing might not increase the risk for newly diagnosed SUDs in most patients. When stimulants are being prescribed via telehealth, measures to prevent misuse may be particularly important among people ages 26-34.