Behavioral health telehealth utilization during the pandemic among adults with opioid use disorder and behavioral health utilization in the year prior to COVID-19: Differences by payor source, treatment type, and patient demographics.

Telehealth can facilitate continuity of behavioral health treatment for opioid use disorder (OUD). Use of telehealth significantly changed during COVID-19, but it is unknown how implementation differed across payors nationally. Adults with OUD and a behavioral health treatment claim for OUD between January 2019 and February 2020, separated by commercial (N = 23,048), Medicaid (N = 87,303), or Veterans Health Administration (N = 84,597), were included. We performed descriptive analysis using longitudinal claims and electronic health record data from 2019 to 2021 and logistic regressions to evaluate associations between patient characteristics and utilization of telehealth visits in the pandemic period. Prior to the pandemic, 0.26%, 1.16%, and 2.67% of adults covered by commercial, Medicaid, or Veterans Health Administration had a telebehavioral health visit each month, respectively. Between April 2020 and March 2021, these averages increased to 12.7%, 18.8%, and 15.8%, respectively. Rates of in-person treatment dropped at pandemic onset but remained the primary modality. Age, sex, health plan type, co-occurring conditions, and comorbidity were all associated with telehealth use, and these variables differed between payors. Although in-person care for OUD decreased dramatically postpandemic onset, it remained the primary modality for adults with OUD. Despite swift increases in the rate of telehealth care, it was not widely adopted for OUD treatment and uptake differed significantly across payors and patient demographics (e.g., older individuals and veterans). Telehealth was used less for medication management overall, despite regulatory exceptions expanding on this option, also with notable differences across payors. (PsycInfo Database Record (c) 2026 APA, all rights reserved).