{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T03:02:24Z","timestamp":1791860544179,"version":"4.3.4"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Early COVID-19 mitigation strategies placed an additional burden on individuals seeking care for opioid use disorder (OUD). Telemedicine provided a way to initiate and maintain transmucosal buprenorphine treatment of OUD.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To examine associations between transmucosal buprenorphine OUD treatment modality (telemedicine vs traditional) during the COVID-19 public health emergency and the health outcomes of treatment retention and opioid-related nonfatal overdose.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective cohort study was conducted using Medicaid claims and enrollment data from November 1, 2019, to December 31, 2020, for individuals aged 18 to 64 years from Kentucky and Ohio. Data were collected and analyzed in June 2022, with data updated during revision in August 2023.<\/jats:p>\n <\/jats:sec>\n \n Exposures<\/jats:title>\n The primary exposure of interest was the modality of the transmucosal buprenorphine OUD treatment initiation. Relevant patient demographic and comorbidity characteristics were included in regression models.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n There were 2 main outcomes of interest: retention in treatment after initiation and opioid-related nonfatal overdose after initiation. For outcomes measured after initiation, a 90-day follow-up period was used. The main analysis used a new-user study design; transmucosal buprenorphine OUD treatment initiation was defined as initiation after more than a 60-day gap in buprenorphine treatment. In addition, uptake of telemedicine for buprenorphine was examined, overall and within patients initiating treatment, across quarters in 2020.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n This study included 41\u202f266 individuals in Kentucky (21\u202f269 women [51.5%]; mean [SD] age, 37.9 [9.0] years) and 50\u202f648 individuals in Ohio (26\u202f425 women [52.2%]; mean [SD] age, 37.1 [9.3] years) who received buprenorphine in 2020, with 18\u202f250 and 24\u202f741 people initiating buprenorphine in Kentucky and Ohio, respectively. Telemedicine buprenorphine initiations increased sharply at the beginning of 2020. Compared with nontelemedicine initiation, telemedicine initiation was associated with better odds of 90-day retention with buprenorphine in both states (Kentucky: adjusted odds ratio, 1.13 [95% CI, 1.01-1.27]; Ohio: adjusted odds ratio, 1.19 [95% CI, 1.06-1.32]) in a regression analysis adjusting for patient demographic and comorbidity characteristics. Telemedicine initiation was not associated with opioid-related nonfatal overdose (Kentucky: adjusted odds ratio, 0.89 [95% CI, 0.56-1.40]; Ohio: adjusted odds ratio, 1.08 [95% CI, 0.83-1.41]).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study of Medicaid enrollees receiving buprenorphine for OUD, telemedicine buprenorphine initiation was associated with retention in treatment early during the COVID-19 pandemic. These findings add to the literature demonstrating positive outcomes associated with the use of telemedicine for treatment of OUD.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.36914","type":"journal-article","created":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T11:03:22Z","timestamp":1697627002000},"page":"e2336914","source":"Crossref","is-referenced-by-count":64,"title":["Telemedicine Buprenorphine Initiation and Retention in Opioid Use Disorder Treatment for Medicaid Enrollees"],"prefix":"10.1001","volume":"6","author":[{"given":"Lindsey R.","family":"Hammerslag","sequence":"first","affiliation":[{"name":"Institute for Biomedical Informatics, University of Kentucky College of Medicine, Lexington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimee","family":"Mack","sequence":"additional","affiliation":[{"name":"Division of Health Sciences, The Ohio State University Wexner Medical Center, Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Redonna K.","family":"Chandler","sequence":"additional","affiliation":[{"name":"National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura C.","family":"Fanucchi","sequence":"additional","affiliation":[{"name":"Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel J.","family":"Feaster","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc R.","family":"LaRochelle","sequence":"additional","affiliation":[{"name":"Clinical Addiction Research & Education Unit, Boston University School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle R.","family":"Lofwall","sequence":"additional","affiliation":[{"name":"Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Nau","sequence":"additional","affiliation":[{"name":"Division of Health Sciences, The Ohio State University Wexner Medical Center, Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Villani","sequence":"additional","affiliation":[{"name":"National Institute on Drug Abuse, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon L.","family":"Walsh","sequence":"additional","affiliation":[{"name":"Center on Drug and Alcohol Research, College of Medicine, University of Kentucky, Lexington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip M.","family":"Westgate","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, College of Public Health, University of Kentucky, Lexington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svetla","family":"Slavova","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, College of Public Health, University of Kentucky, Lexington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffery C.","family":"Talbert","sequence":"additional","affiliation":[{"name":"Institute for Biomedical Informatics, University of Kentucky College of Medicine, Lexington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,10,18]]},"reference":[{"issue":"7","key":"zoi231073r1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2021.1529","article-title":"Changes in short-term, long-term, and preventive care delivery in US office-based and telemedicine visits during the COVID-19 pandemic.","volume":"2","author":"Cortez","year":"2021","journal-title":"JAMA Health Forum"},{"issue":"7","key":"zoi231073r2","doi-asserted-by":"publisher","first-page":"1284","DOI":"10.2105\/AJPH.2021.306256","article-title":"COVID-19 and the drug overdose crisis: uncovering the deadliest months in the United States, January\u2013July 2020.","volume":"111","author":"Friedman","year":"2021","journal-title":"Am J Public Health"},{"issue":"12","key":"zoi231073r6","doi-asserted-by":"publisher","first-page":"1147","DOI":"10.1001\/jama.2021.0958","article-title":"Removing one barrier to opioid use disorder treatment: is it enough?","volume":"325","author":"Weimer","year":"2021","journal-title":"JAMA"},{"issue":"3","key":"zoi231073r7","doi-asserted-by":"publisher","first-page":"388","DOI":"10.1001\/jamainternmed.2020.5928","article-title":"Trends in outpatient care delivery and telemedicine during the COVID-19 pandemic in the US.","volume":"181","author":"Patel","year":"2021","journal-title":"JAMA Intern Med"},{"issue":"1","key":"zoi231073r8","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1111\/jrh.v37.1","article-title":"Integrating telemedicine for medication treatment for opioid use disorder in rural primary care: beyond the COVID pandemic.","volume":"37","author":"Hser","year":"2021","journal-title":"J Rural Health"},{"key":"zoi231073r13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2020.108196","article-title":"Medication treatment for opioid use disorder in the age of COVID-19: can new regulations modify the opioid cascade?","volume":"122","author":"Nunes","year":"2021","journal-title":"J Subst Abuse Treat"},{"issue":"1","key":"zoi231073r15","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.42531","article-title":"Use of telemedicine for buprenorphine inductions in patients with commercial insurance or Medicare Advantage.","volume":"5","author":"Barsky","year":"2022","journal-title":"JAMA Netw Open"},{"issue":"10","key":"zoi231073r16","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1001\/jamapsychiatry.2022.2284","article-title":"Receipt of telehealth services, receipt and retention of medications for opioid use disorder, and medically treated overdose among Medicare beneficiaries before and during the COVID-19 pandemic.","volume":"79","author":"Jones","year":"2022","journal-title":"JAMA Psychiatry"},{"issue":"10","key":"zoi231073r17","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1176\/appi.ajp.21111141","article-title":"Impact of COVID-19 telehealth policy changes on buprenorphine treatment for opioid use disorder.","volume":"179","author":"Lin","year":"2022","journal-title":"Am J Psychiatry"},{"key":"zoi231073r18","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2020.108335","article-title":"The HEALing (Helping to End Addiction Long-term) Communities Study: protocol for a cluster randomized trial at the community level to reduce opioid overdose deaths through implementation of an integrated set of evidence-based practices.","volume":"217","author":"Walsh","year":"2020","journal-title":"Drug Alcohol Depend"},{"key":"zoi231073r19","article-title":"Retention strategies for medications for addiction treatment in adults with opioid use disorder: a rapid evidence review.","author":"Chan","journal-title":"J Addict Med"},{"key":"zoi231073r20","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1016\/j.drugalcdep.2017.01.048","article-title":"The effectiveness of telemedicine-delivered opioid agonist therapy in a supervised clinical setting.","volume":"176","author":"Eibl","year":"2017","journal-title":"Drug Alcohol Depend"},{"issue":"7","key":"zoi231073r21","doi-asserted-by":"publisher","first-page":"1610","DOI":"10.1007\/s11606-021-06969-1","article-title":"Telehealth utilization is associated with lower risk of discontinuation of buprenorphine: a retrospective cohort study of US veterans.","volume":"37","author":"Vakkalanka","year":"2022","journal-title":"J Gen Intern Med"},{"issue":"4","key":"zoi231073r22","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/j.ypmed.2007.08.012","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"45","author":"von Elm","year":"2007","journal-title":"Prev Med"},{"issue":"6","key":"zoi231073r26","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2023.1422","article-title":"Trends in use of medication to treat opioid use disorder during the COVID-19 pandemic in 10 state Medicaid programs.","volume":"4","author":"Austin","year":"2023","journal-title":"JAMA Health Forum"},{"issue":"4","key":"zoi231073r27","doi-asserted-by":"publisher","first-page":"836","DOI":"10.1055\/s-0041-1733848","article-title":"Telemedicine adoption during the COVID-19 pandemic: gaps and inequalities.","volume":"12","author":"Luo","year":"2021","journal-title":"Appl Clin Inform"},{"key":"zoi231073r28","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1016\/j.genhosppsych.2020.09.004","article-title":"Disparities in outpatient visits for mental health and\/or substance use disorders during the COVID surge and partial reopening in Massachusetts.","volume":"67","author":"Yang","year":"2020","journal-title":"Gen Hosp Psychiatry"},{"issue":"10","key":"zoi231073r29","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.36298","article-title":"Use of and retention on video, telephone, and in-person buprenorphine treatment for opioid use disorder during the COVID-19 pandemic.","volume":"5","author":"Frost","year":"2022","journal-title":"JAMA Netw Open"},{"key":"zoi231073r30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2020.108124","article-title":"Treatment of opioid use disorder during COVID-19: experiences of clinicians transitioning to telemedicine.","volume":"118","author":"Uscher-Pines","year":"2020","journal-title":"J Subst Abuse Treat"},{"issue":"12","key":"zoi231073r31","doi-asserted-by":"publisher","first-page":"1940","DOI":"10.1377\/hlthaff.2018.05134","article-title":"How is telemedicine being used in opioid and other substance use disorder treatment?","volume":"37","author":"Huskamp","year":"2018","journal-title":"Health Aff (Millwood)"},{"issue":"2","key":"zoi231073r36","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1001\/jama.2021.7374","article-title":"Use of medications for treatment of opioid use disorder among US Medicaid enrollees in 11 states, 2014-2018.","volume":"326","author":"Donohue","year":"2021","journal-title":"JAMA"},{"issue":"11","key":"zoi231073r37","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2021.3833","article-title":"Assessment of state and federal health policies for opioid use disorder treatment during the COVID-19 pandemic and beyond.","volume":"2","author":"Pessar","year":"2021","journal-title":"JAMA Health Forum"},{"issue":"3","key":"zoi231073r38","doi-asserted-by":"publisher","first-page":"634","DOI":"10.3122\/jabfm.2022.03.210483","article-title":"Factors associated with never having had a video visit.","volume":"35","author":"Leung","year":"2022","journal-title":"J Am Board Fam Med"},{"issue":"10","key":"zoi231073r40","doi-asserted-by":"publisher","first-page":"950","DOI":"10.1001\/jamapsychiatry.2022.2032","article-title":"A case for permanent adoption of expanded telehealth services and prescribing flexibilities for opioid use disorder: insights from pandemic-prompted emergency authorities.","volume":"79","author":"Czeisler","year":"2022","journal-title":"JAMA Psychiatry"},{"key":"zoi231073r41","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2020.102905","article-title":"Continuing increased access to buprenorphine in the United States via telemedicine after COVID-19.","volume":"93","author":"Davis","year":"2021","journal-title":"Int J Drug Policy"},{"issue":"12","key":"zoi231073r42","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1001\/jamapsychiatry.2020.1698","article-title":"Telehealth for substance-using populations in the age of coronavirus disease 2019: recommendations to enhance adoption.","volume":"77","author":"Lin","year":"2020","journal-title":"JAMA Psychiatry"},{"key":"zoi231073r43","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2021.108999","article-title":"Use of telemedicine for opioid use disorder treatment\u2014perceptions and experiences of opioid use disorder clinicians.","volume":"228","author":"Riedel","year":"2021","journal-title":"Drug Alcohol Depend"},{"key":"zoi231073r33","year":"2022"},{"key":"zoi231073r3","unstructured":"Ohio Department of Health. Director\u2019s stay at home order. Published online March 22, 2020. Accessed August 15, 2023. https:\/\/content.govdelivery.com\/attachments\/OHOOD\/2020\/03\/22\/file_attachments\/1407840\/Stay%20Home%20Order.pdf"},{"key":"zoi231073r4","unstructured":"Ohio Department of Health. Governor DeWine announces details of Ohio\u2019s Responsible RestartOhio Plan. Published online April 27, 2020. Accessed August 15, 2023. https:\/\/coronavirus.ohio.gov\/resources\/news-releases-news-you-can-use\/governor-dewine-announces-details-ohios-responsible-restartohio-plan"},{"key":"zoi231073r5","unstructured":"Kentucky Governor Andy Beshear. Kentucky\u2019s response to COVID-19. Published online October 20, 2020. Accessed August 15, 2023. https:\/\/governor.ky.gov\/Documents\/20201020_COVID-19_page-archive.pdf"},{"key":"zoi231073r9","unstructured":"Chu? RC, Peters? C, De Lew? N, Sommers? BD. State Medicaid telehealth policies before and during the COVID-19 public health emergency. Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services. Published online July 2021. Accessed May 31, 2022. https:\/\/aspe.hhs.gov\/sites\/default\/files\/documents\/eb9e147935a2663441a9488e36eea6cb\/medicaid-telehealth-brief.pdf"},{"key":"zoi231073r10","unstructured":"Lee? NT, Karsten? J, Roberts? J. Removing regulatory barriers to telehealth before and after COVID-19. Brookings. May 6, 2020. Accessed May 31, 2022. https:\/\/www.brookings.edu\/articles\/removing-regulatory-barriers-to-telehealth-before-and-after-covid-19\/"},{"key":"zoi231073r11","unstructured":"Drug Enforcement Administration; Diversion Control Division. How to prescribe controlled substances to patients during the COVID-19 public health emergency. Published online 2020. Accessed November 3, 2022. https:\/\/www.deadiversion.usdoj.gov\/GDP\/RESCINDED_(DEA-DC-023)(DEA075)Decision_Tree_(Final)_33120_2007.pdf"},{"key":"zoi231073r12","unstructured":"Drug Enforcement Administration; Diversion Control Division. COVID-19 information page. Published March 16, 2020. Accessed May 31, 2022. https:\/\/web.archive.org\/web\/20230203135106\/https:\/\/www.deadiversion.usdoj.gov\/coronavirus.html"},{"key":"zoi231073r14","unstructured":"Prevoznik? TW. DEA068 DEA SAMHSA buprenorphine telemedicine. US Department of Justice, Drug Enforcement Administration. Published online March 31, 2020. Accessed September 1, 2022. https:\/\/www.deadiversion.usdoj.gov\/GDP\/(DEA-DC-022)(DEA068)%20DEA%20SAMHSA%20buprenorphine%20telemedicine%20%20(Final)%20+Esign.pdf"},{"key":"zoi231073r23","unstructured":"Centers for Medicare & Medicaid Services. COVID-19 frequently asked questions (FAQs) on Medicare fee-for-service (FFS) billing. Published online March 27, 2020. Accessed November 11, 2021. https:\/\/www.cms.gov\/files\/document\/03092020-covid-19-faqs-508.pdf"},{"key":"zoi231073r24","unstructured":"American Academy of Family Physicians. COVID-19 private payer frequently asked questions. Published online January 27, 2020. Accessed September 28, 2021. https:\/\/www.aafp.org\/dam\/AAFP\/documents\/practice_management\/covid-19\/payer-faqs.pdf"},{"key":"zoi231073r25","unstructured":"Kentucky Cabinet for Health and Family Services, Department for Medicaid Services. Medicaid COVID-19 FAQs. Published online July 2020. Accessed September 22, 2021. https:\/\/www.chfs.ky.gov\/agencies\/dms\/Documents\/ProviderFAQs.pdf"},{"key":"zoi231073r32","unstructured":"Kentucky Board of Medical Licensure. Board opinion relating to online\/virtual medication assisted treatment (MAT). Published online December 16, 2021. Accessed March 1, 2023. https:\/\/kbml.ky.gov\/board\/Documents\/Board%20Opinion%20Relating%20to%20Online%20Virtual%20Medication%20Assisted%20Treatment.pdf"},{"key":"zoi231073r34","unstructured":"Kentucky General Assembly. Title 201: chapter 009: regulation 270: professional standards for prescribing, dispensing, or administering buprenorphine-mono-product or buprenorphine-combined-with-naloxone. December 15, 2021. Accessed March 1, 2023. https:\/\/apps.legislature.ky.gov\/law\/kar\/titles\/201\/009\/270\/"},{"key":"zoi231073r35","unstructured":"Caudell-Feagan? M, Huh? K, Dube? S, . Overview of opioid treatment program regulations by state. The Pew Charitable Trusts. Published online September 19, 2022. Accessed March 1, 2023. https:\/\/www.pewtrusts.org\/en\/research-and-analysis\/issue-briefs\/2022\/09\/overview-of-opioid-treatment-program-regulations-by-state"},{"key":"zoi231073r39","unstructured":"Gifford? K, Lashbrook? A, Barth? S, . States respond to COVID-19 challenges but also take advantage of new opportunities to address long-standing issues: results from a 50-state Medicaid budget survey for state fiscal years 2021 and 2022. Published online October 27, 2021. Accessed August 14, 2023. https:\/\/www.kff.org\/report-section\/states-respond-to-covid-19-challenges-but-also-take-advantage-of-new-opportunities-to-address-long-standing-issues-benefits-and-telehealth\/"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2810828\/hammerslag_2023_oi_231073_1697031989.25419.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T11:03:29Z","timestamp":1697627009000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2810828"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,18]]},"references-count":43,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2023,10,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2023.36914","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,18]]}}}