Comparison of buprenorphine treatment by virtual-only vs. traditional clinicians

Few patients with opioid use disorder (OUD) receive medications for OUD (MOUD), such as buprenorphine. Given that many patients, particularly those in rural communities, do not live near a clinician who prescribes MOUD, telemedicine could increase MOUD access. Some clinicians have adopted a virtual-only model of care delivery, which in theory could reach anyone. However, clinicians and policymakers are concerned about the quality of the virtual-only model.

We identified adults with commercial or Medicare Advantage coverage via UnitedHealthCare who started buprenorphine for OUD between September 2019 and December 2023. We compared the care provided by virtual-only vs. traditional clinicians.

There were 17,538 buprenorphine inductions during the study period, of which 568 (3.2%) were conducted by a virtual-only clinician. There were few substantive differences in who used virtual-only care. For example, patients initiating buprenorphine with virtual-only vs. traditional clinicians were equally likely to live in urban areas (82.6% vs. 80.4%, p = 0.53). Patients initiating buprenorphine with virtual-only clinicians had more visits in the 6 months after the initiation (8.5 vs. 5.7 visits, p < 0.01), were more likely to be on buprenorphine at 6 months (59.0% vs. 52.9%, p < 0.01), but had fewer days of continuous buprenorphine treatment (70.7 vs. 81.9, p < 0.01).

Our results can inform ongoing debates about the strengths and weaknesses of virtual-only OUD care.