Telemedicine Can Help Facilitate Treatment for Opioid Use Disorder

More than half of patients who were prescribed a medication for opioid use disorder through a virtual program established during the pandemic continued with treatment for at least 1 month after the program, according to researchers from the Perelman School of Medicine at the University of Pennsylvania.

The CareConnect program was established via a partnership between the University of Pennsylvania’s 24/7 virtual urgent care, Penn Medicine OnDemand, and a team of substance use navigators. Trained urgent care clinicians provide a virtual assessment and treatment with buprenorphine, a medication for opioid cravings and withdrawal symptoms. Patients also receive support from substance use navigators throughout the care process.

The results show that 89% of patients in the program filled their first prescription of buprenorphine. Further, 55% continued to have an “active prescription” for the medication 30 days after being first engaged, which indicated they were still actively in treatment, according to the study authors.

“The numbers are encouraging and likely may even be an underestimate when it comes to who is in active treatment, since it does not capture people in other modes of care, such as methadone, or those who have entered inpatient rehabilitation,” said study lead author, Margaret Lowenstein, MD, an assistant professor of medicine and research director of the Penn Center for Addiction Medicine and Policy (CAMP), in a press release.

Because of the COVID-19 pandemic, regulations for prescribing buprenorphine were suspended on an emergency basis, allowing CAMP to develop a predecessor to CareConnect. The pilot telemedicine-based service provided short-term prescriptions for buprenorphine and linked patients to longer-term treatment services. These services included additional prescriptions for buprenorphine or other medications, care for other chronic conditions, and connections with social services.

This also allowed patients who may find substance use care in emergency departments to avoid the hospital and access treatment without needing to travel, which was identified as a significant barrier for some patients, especially during the COVID-19 pandemic.

The pilot program helped patients overcome barriers to treatment; however, the investigators said there was no infrastructure to schedule or efficiently document care, among other areas that needed to be established for a widescale program.

“The strength of a program like this is in the ways it fills all of the gaps: For an average patient seeking treatment, there are few—if any—places that can offer treatment on the same or next day, and even then, patients have to manage a variety of barriers such as childcare or transportation,” Lowenstein said in a press release. “CareConnect allows patients to get their prescription for buprenorphine as soon as they need it and provides the help needed to navigate all of the hurdles a patient faces until they can be stably linked to care.”

Another benefit of the program was the support it offers for patients transitioning between different levels of care, such as being discharged following a hospitalization and transferring back to a community care provider.

“The hospital clinicians call CareConnect because they know their patients will get supported in each step needed to make that transition” said senior author Jeanmarie Perrone, MD, a professor of emergency medicine and founding director of CAMP, in a press release. “In addition, other emergency departments in the region are starting to prescribe buprenorphine and call CareConnect to arrange the follow up and ‘warm handoff’ to the next provider. This expands the safety net for patients to find treatment more readily.”

The study noted that the program received 371 calls and provided 249 buprenorphine prescriptions from November 2021 through September 2022. The study authors said they hope to expand the program to a wider population in the future.

“This is one of the few places that offers consistent same-day buprenorphine treatment access in Philadelphia,” Lowenstein said in a press release. “The alternative is often an emergency department or crisis center or, worst case, going without care. So we’re talking about saving hundreds of visits to the emergency department and/or hundreds of people saved from going without any care at all.”

REFERENCE

Telemedicine Program CareConnect Helps Eliminate Barriers for Opioid Use Disorder Treatment. November 16, 2022. Accessed November 17, 2022. https://www.pennmedicine.org/news/news-releases/2022/november/careconnect-lowers-opioid-use-disorder-treatment-barriers