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Impact of State Telemedicine Policies on Substance Use Disorder Treatment During the COVID-19 Pandemic

Matthew D Eisenberg^1,2, Kayla N Tormohlen^3,4, Alexander D McCourt⁵

¹Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. eisenberg@jhu.edu.

Journal of General Internal Medicine

|April 17, 2026

Abstract

Importance:

The COVID-19 pandemic disrupted traditional substance use disorder (SUD) treatment modalities, prompting innovative telemedicine solutions.

Objective:

To evaluate the association between state-level telemedicine policies and SUD treatment during the COVID-19 pandemic.

Design:

An augmented synthetic control analysis comparing changes in SUD treatment before and after the implementation of telemedicine policies in states that adopted these policies to changes in SUD treatment in comparison states without these policies from 2018 to 2022.

Setting:

This study utilized a comprehensive policy database merged with de-identified patient claims data from the OptumLabs® Data Warehouse.

Participants:

Individuals aged 18 in only fully insured commercial, private plans subject to state insurance policies between January 2018 and December 2022.

Exposure:

Combined implementation of three state telemedicine policies during the early months of the COVID-19 pandemic (March-July 2020), including telemedicine coverage parity, telemedicine payment parity, and in-person relationship waivers.

Main Outcomes:

SUD treatment initiation and continuation, measured at the patient-month level and aggregated to the state-month level for analyses, with subgroup analyses for opioid use disorder (OUD) and alcohol use disorder (AUD) treatment.

Results:

Implementation of the three policies was associated with average effects of less than 0.006 percentage points in the proportion of adults initiating SUD, AUD, or OUD treatment between March/April 2020 and December 2022, with confidence intervals not exceeding a 0.02 percentage point increase or decrease (p > 0.05). Among adults receiving treatment prior to the COVID-19 pandemic, these policies were associated with an estimated average change of less than 1.5 percentage points in the proportion of adults receiving SUD, AUD, or OUD treatment, with confidence intervals not exceeding a 4.5 percentage point increase or decrease (p > 0.05).

Conclusions And Relevance:

Our study did not identify impacts of state telemedicine coverage parity, payment parity, and in-person relationship waiver policies on SUD treatment during the COVID-19 pandemic.

Keywords:

pandemic policy substance use disorder telemedicine

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