Dive Brief:

• Medicaid beneficiaries who began using buprenorphine, a medication that treats opioid use disorder, via telemedicine early in the COVID-19 pandemic were more likely to stay in treatment than non-telemedicine initiation, according to a study published in JAMA Network Open.
• The study found enrollees faced the same odds of non-fatal overdose when starting buprenorphine through telehealth, suggesting virtual care can improve access to treatment — which can be a major challenge for people who struggle with the disorder.
• The research comes as permanent regulations for telehealth prescriptions of controlled substances remain up in the air. The Drug Enforcement Administration and the HHS announced earlier this month they’ll temporarily extend the pandemic-era flexibilities through 2024.

Dive Insight:

Drug overdose deaths increased during the COVID-19 pandemic, reaching more than 100,000 in 2021, according to the Centers for Disease Control and Prevention. More than 75% of those deaths involved opioids.

Stay-at-home orders and social distancing disrupted healthcare delivery, which might have contributed to the increase in overdose deaths, noted the JAMA study’s authors.

In a bid to avoid lapses in care, regulators and lawmakers created new telehealth rules, like reimbursing visits at the same rate as in-person care and waiving licensing requirements for out-of-state clinicians.

The DEA also granted exceptions to the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which required most practitioners to have at least one in-person evaluation before prescribing controlled substances like buprenorphine.

Those prescription flexibilities were originally set to expire in May alongside the rest of the public health emergency. However, the rules were instead extended until November after regulators received more than 38,000 public comments on proposed rules that would have added more limitations to telehealth controlled substance prescriptions.

Earlier this month, the rules were temporarily extended again through the end of 2024, after organizations like the American Telemedicine Association and the American Hospital Association argued that in-person requirements could limit access to care, particularly for opioid use disorders.

The latest JAMA study, which used Medicaid data on more than 91,000 people from Kentucky and Ohio, is in line with previous research that found expanded telehealth services could improve care for people with opioid use disorder.

“This finding may be especially valuable for improving MOUD [medications for opioid use disorder] access in states such as Kentucky, which has historically had restrictive buprenorphine access policies and restrictive methadone regulations, as well as a large rural population,” the study’s authors wrote. “Telemedicine may also increase access in underserved areas, adding to the workforce for behavioral health services in rural areas.”

However, researchers did note racial disparities when it came to telehealth access and retention. Non-Hispanic Black people had lower odds of telemedicine initiation compared with White individuals, and about half the odds of being retained in buprenorphine treatment at 90 days.

  The Centers for Disease Control and Prevention (CDC) examines vaccine confidence and uptake among rural populations in the United States between 2017-2023, with a focus on COVID-19 vaccination. The report covers differences in vaccine uptake among urban, suburban, and rural populations and identifies strategies for successful outreach to rural areas.

In an ongoing collaboration with the Center for Rural Pennsylvania, the Pennsylvania State Data Center (PaSDC) has produced population projections for Pennsylvania for the state and its counties, categorized by age and sex, extending through the year 2050.

PaSDC utilized a cohort-component model consistent with 47 other states’ methodologies to generate for each five-year interval from 2020 to 2050. The projections show that the state’s population is on track to grow by just over 200,000 (+1.6%) from 2020 to 2050.

To access an overview of the projections data along with visuals exploring the projections, please visit our latest brief, Pennsylvania Population Projections: 2020 to 2050.

For more highlights on these projections, their policy implications, and the press conference for their release, please visit: https://www.rural.pa.gov/data/population-projections.

Researchers analyzed survey responses to the 2021 Public Health Workforce Interest and Needs Survey to compare rural and urban skill proficiencies, training needs, turnover risk, and experiences of bullying due to working as a public health professional.  Among the findings, rural staff had a higher likelihood than urban staff of reporting proficiencies in community engagement, data-based decision-making, and diversity, equity, and inclusion.  Rural staff were also more likely than urban staff to report leaving because of stress, experiences of bullying, and avoiding situations that made them think about COVID-19.

This report examines what was learned from North Carolina’s Healthy Opportunities Pilots, a project launched in 2021 with $650 million in Medicaid funding that focused on the health-related social needs of enrollees living in three primarily rural regions of the state.

  The national nonprofit Kaiser Family Foundation highlights state policies and recent research related to over-the-counter (OTC) access to naloxone, a drug that rapidly reverses opioid overdose.  A clue may be provided by a 2022 study linked in the brief that examines how pharmacies decided to stock the prescription version of the drug.  The study identified that independent pharmacies, those in rural areas, and pharmacies in states with lower overdose rates or without expanded Medicaid were less likely to have it available.

In June 2023, the three FORHP-supported Rural Centers of Excellence on Substance Use Disorders – University of Vermont Center on Rural Addiction, University of Rochester, and the Fletcher Group – collaborated to conduct an online survey of practitioners affiliated with grant sites of FORHP’s Rural Communities Opioid Response Program.

On September 1, 2023, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule that would create new requirements for nurse staffing levels in nursing facilities, settings that provide medical and personal care services for nearly 1.2 million Americans. The adequacy of staffing in nursing homes has been a longstanding issue. A recent report issued by the National Academy of Sciences, Engineering, and Medicine (NASEM) raised concerns about low nursing staff levels in nursing facilities across the country and the impact on the quality of care for nursing home residents. The high mortality rate in nursing facilities during the COVID-19 pandemic highlighted and intensified the consequences of inadequate staffing levels.

The new proposed rule includes several provisions to bolster staffing in nursing homes. It proposes a minimum of 0.55 registered nurse (RN) and 2.45 nurse aide hours per resident day; requires facilities to have an RN on staff 24 hours per day, 7 days per week; strengthens staffing assessment and enforcement strategies; creates new reporting requirements regarding Medicaid payments for institutional long-term services and supports (LTSS); and provides $75 million for training for nurse aides. As noted in the proposed rule, CMS aims to balance the goal of establishing stronger staffing requirements against the practicalities of implementation and costs. Comments on the proposed rule are due by November 6, 2023.

This issue brief analyzes the percentage and characteristics of facilities that would meet the rule’s proposed requirements for the minimum number of RN and nurse aide hours to better understand the implications of the rule. The analysis does not evaluate facilities’ ability to comply with other requirements, including the requirement to always have a registered nurse on duty 24/7 or the ability to meet the new reporting and assessment requirements due to data limitations (see methods). The analysis uses Nursing Home Compare data, which include 14,591 nursing facilities (97% of all facilities, serving 1.17 million or 98% of all residents) that reported staffing levels in August 2023.

Click here to read more and to access the brief.

Individuals with opioid use disorder (OUD) who were prescribed a lower buprenorphine dose were 20% more likely to discontinue treatment than those on a higher dose, according to a study of patients prescribed buprenorphine in Rhode Island from 2016 to 2020, as fentanyl became widely available. “The current recommended target dose of buprenorphine was derived from studies conducted prior to the widespread availability of fentanyl. Now, we’re seeing people with higher levels of tolerance to and dependence on opioids, and our findings suggest that a higher buprenorphine dose – up to 24 mg – may help improve treatment retention for these individuals,” said Rachel Wightman, M.D., Associate Professor of Emergency Medicine and Epidemiology at Alpert Medical School of Brown University and one of the principal investigators of the study.