It’s time to stop believing fake news about telehealth for opioid use disorder

Expanding access to medication-based care and improving treatment retention for patients with OUD is vital to address the worsening opioid overdose crisis.

Technology-enabled telehealth platforms have proven to be important tools for increasing access, retention, and patient satisfaction with evidence-based OUD care¹. However, simply replicating traditional in-person care models in a telehealth format underutilizes all the promise these technologies have to offer. Telehealth is not a single entity. Prior to March 2020, only 14,000 Medicare beneficiaries had received a telehealth service in a given week for any condition, while over 10.1 million utilized telehealth by mid-2020 following the COVID-19 onset². This massive spike in usage demonstrates the need for and willingness to adopt telemedicine across both patients and providers. In combination with the possibility of superior clinical outcomes, scaling access to remote care could have a measurable public health impact on the opioid crisis. 

Ophelia was designed to be a remote-only telehealth company to provide treatment for patients with opioid addiction. Unlike many in-person care settings that had to quickly pivot to telehealth during COVID, Ophelia was conceived in 2019 before the world recognized a global pandemic was on our doorstep. Ophelia provides real-time, face-to-face care, all designed to be delivered virtually. In addition to a primary prescriber, each patient meets with a nurse care manager and a care coordinator for the duration of their care journey. These wraparound services help troubleshoot problems with pharmacies and insurance plans. As a result, fewer logistical hurdles stand in the way of initiating and continuing medication-based treatment.  

One of the best markers for care quality is long-term retention. Ophelia’s 180-day patient retention rate is 60%, which is far superior to results from prior studies of patients receiving in-person buprenorphine-based treatment across multi-site treatment settings pre-COVID. Prior reports analyzing Medicaid beneficiaries (27.0%)³, commercial insurance enrollees (31.0%)⁴, and prescription drug monitoring program data (37.5%)⁵ have much worse results. For reference, this 180-day retention rate rivals that of popular streaming services such as Netflix. And it’s even higher (~80%) for patients who can use their insurance to pay for care.  

There is a growing chorus calling for regulators to make the COVID-era policy changes permanent and allow for expansion of buprenorphine induction and maintenance services via telehealth. Such changes have already facilitated innovation and might allow creation of new models which harness technological solutions and solve barriers to care that exist in the office-based settings. Ophelia data suggest that for some patients the virtual care models may prove superior to returning to in-person care and related requirements. In addition, policy allowing for practice across state lines – critical during the COVID-19 pandemic -- has decreased burdens for clinicians and effectively expanded access to OUD care via telehealth, especially in rural and traditionally underserved areas. 

When quality care, improved access, and better retention is clearly the result of using telemedicine to treat opioid addiction– and at a lower cost– we need to stop asking if telehealth is “equal” to in-person care and keep looking for ways to reach more people with virtual care. In addition to removing regulatory roadblocks that hamper access to lifesaving telehealth-based care, our elected officials and policymakers could be promoting telehealth as a critical force for responding to the opioid and addiction crisis.

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