Availability of Telehealth in Substance Use Treatment Facilities and Overdose Mortality During COVID-19

Authors: Michael DiNardi (University of Rhode Island), William L. Swann (University of Colorado – Denver), and Sarah Dzwil (University of Rhode Island)

Abstract: 

COVID-19 response exacerbated social isolation and risk of overdose death for people with substance use disorder. Policymakers and health providers counteracted with ramping up substance use treatment via telehealth. We investigate whether increased availability of telehealth in substance use treatment facilities affected drug overdose mortality rates during COVID-19. Methods: We use difference-in-differences regression to compare drug overdose mortality per 100,000 population over 2014-2020 in nearly all US counties with different rates of substance use treatment via telehealth in 2019, with survey data from the National Survey of Substance Abuse Treatment Services. We also examine differences across racial and ethnic groups and whether Medicaid expansion states had a moderating effect. Results: The total number of telehealth facilities per 100,000 population nearly doubled from 1.14 in 2019 to 2.52 in 2020, and we estimate that one additional telehealth treatment facility per 100,000 in 2019 is associated with 1.3 additional telehealth facilities per 100,000 in 2020, an effect that is statistically significant at the one percent level. The difference-in-difference estimate does not show a statistically significant effect of telehealth-providing substance use facilities on opioid mortality rates in 2020. At a 95 percent confidence level, we are unable to detect effect sizes of one additional telehealth-providing facility decreasing the opioid mortality rate by 0.23 per 100,000 population, an effect that is less than 2.4 percent of the sample mean (9.8 per 100,000 population).