One in 10 buprenorphine initiations is provided via telehealth, and about 20% of those involved no in-person visit within two years prior or 30 days after, according to a study in today’s JAMA Network Open.
“Our findings suggest that telehealth initiation of buprenorphine without a prior in-person visit is an important pathway for accessing this lifesaving treatment for adults with opioid use disorder,” lead investigator Beth McGinty, Ph.D., M.S., of Weill Cornell Medicine, told Psychiatric News. “The pending final rule on telehealth would support this access, and given that we know buprenorphine reduces risk of opioid overdose by 50%, it would save lives.”
The Drug Enforcement Administration issued a final rule in the waning days of the Biden administration that would allow a clinician to teleprescribe up to six months of buprenorphine without an in-person visit as long as the clinician reviewed the prescription drug monitoring program for the state where the patient resides. The rule had been scheduled to take effect in mid-February, but the Trump administration issued an executive order pausing all federal rules not yet in effect, pending further review.
McGinty and colleagues used IQVIA data to assess buprenorphine initiations from March 2020 through November 2022. The researchers included physicians who continuously practiced from 2018 to 2022 and who had treated at least one patient with opioid use disorder. They measured their proportion of telehealth initiations that had no in-person visit with the prescribing clinician within two years prior, and no in-person visit within two years prior or 30 days after.
During the study timeframe, about 10% of the 228,598 total buprenorphine initiations were via telehealth, involving 3,950 clinicians and 21,220 patients. Among these telehealth initiations, 28% had no in-person visit with the prescribing clinician in the prior two years, while 20% had no in-person visit with the prescriber two years prior or 30 days after. The proportion of telehealth initiations with no in-person visit before or after was higher among behavioral health physicians (27% of all telehealth initiations) than primary care physicians (15%) and nurse practitioners or physician assistants (22%).
“In-person visit requirements can impede access due to limited in-person provider appointment availability and other barriers, such as transportation,” McGinty said. “Additional research is needed to compare the effectiveness of telehealth buprenorphine initiations with and without in-person visits to determine if six months is the ‘right’ duration and to consider … whether fully remote telehealth models with no in-person visits are able to deliver comparably safe and effective care.”
For related information, see the Psychiatric News article “New Rules Allow Telehealth Prescribing, but ‘Special Registration’ Proposal May Create Barriers to Care.”
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