Even before the start of the COVID-19 pandemic, only about 1 in 10 Americans with a substance use disorder (SUD) received specialty treatment, which includes care at a hospital, rehabilitation facility, or mental health center. Today, the need to physically distance presents new risks for people seeking these services. Expanding the use of telehealth services can be an effective option to boost access to treatment, especially for opioid use disorder (OUD), while minimizing potential coronavirus exposure.
Declaration of a federal public health emergency in January eased barriers to certain health care services, allowing counseling and prescribing of medications for treating OUD to be provided over the phone and via video chat. It also helped ensure that these services are eligible for Medicaid and Medicare reimbursement.
The speedy and necessary shift to remote care in response to the pandemic may help expand the body of promising evidence for OUD telehealth services. In the meantime, practices across the country are reporting positive outcomes, particularly in maintaining treatment and reaching certain at-risk patients.
When people with OUD can access care remotely, they may be more likely to use the services than if they had to travel and take time away from other obligations.
Minnesota-based Hazelden Betty Ford is the largest substance use treatment program in the U.S., but it did not have an official “virtual care” system in place before the pandemic, according to a recent report on PBS NewsHour. Program staff quickly launched RecoveryGo, which allows patients to be counseled and treated via video chat on a computer, smartphone, or any device with an internet connection and a camera. Early trials have found that the virtual group attendance rate was higher than facility-based groups.
In Jackson County, Oregon, therapists—including substance use counselors—have seen the show-up rate for appointments improve in recent months with greater use of telehealth services. “People don’t have to struggle with child care or transportation,” Jackie Lien, executive director of the Phoenix Counseling Center, told the local Mail Tribune newspaper. “For certain populations, it’s a better way to reach them.”
Many patients are embracing the change, and practitioners note that some people seem more comfortable talking over the phone or video chat than in person.
Some clinics are working to provide “coordinated care,” a key approach to treating the whole person seeking recovery.
For example, Highmark Inc. and Bright Heart Health, a managed care organization and a provider, respectively, are linking telehealth and coordinated care to serve OUD patients in Pennsylvania, Delaware, and West Virginia. According to Coastal Point, a local newspaper in Delaware, patients can “meet on-demand with medical staff and counselors through a smartphone, tablet or computer,” either through self-referral or a “warm hand-off.” The latter is a concept of coordinated care that involves transitioning an SUD patient from an initial caregiver, such as an emergency room physician, to a primary care doctor or specialist once the patient is stable.
Telehealth is also allowing providers to connect with people seeking OUD treatment in new ways. Dr. Elizabeth Ryan, associate medical director for REACH Medical in Ithaca, New York, recently wrote that the “insights telehealth has given into the daily lives of our patients have been incredible.” She said that staff have been taken “on virtual walking tours of dairy farms, shared work breaks with essential workers, ridden empty buses through distant upstate towns, [and] been shown … tent living conditions.” This information can lead to “critical discoveries” for health care workers, for example shedding light on a patient’s lack of stable housing, which can make recovery more difficult.
Rural areas, where residents may be at high risk for OUD, and regions with lower numbers of clinicians prescribing medications for OUD are especially benefiting from access to virtual treatment during the pandemic.
According to reporting by Interlochen Public Radio in northern Michigan, doctors and patients in the region both felt that it had been too difficult to find medications for OUD. A dearth of doctors able to prescribe buprenorphine, one of the three medications approved by the U.S. Food and Drug Administration to treat OUD, led to long waitlists and drives to clinics an hour or more away. But expanded insurance reimbursement for telehealth visits appears to be encouraging more rural patients and doctors to take advantage of SUD treatment. One local practice reported adding about 20 new patients in a month since starting telehealth services; some of them had been getting treatment at in-patient facilities that had closed, while others had been driving hours to get medication.
In rural Colorado, clinicians at one outpatient treatment center call telehealth a “game-changer.” Tony Sullivan, chief clinical officer at Solvista Health in Cañon City, told the Colorado Independent that transportation has historically been a barrier to SUD treatment, “particularly for people who don’t have a car or can’t get off a snow-covered mountain.” After struggling to implement telehealth for more than year, the clinic was able to transition within two days because of the relaxed federal regulations. For patients who do not have internet access, counselors have been able to provide therapy over the phone, while patients without phones have been given gift cards to purchase them.
Providers acknowledge the critical value of “face-to-face” meetings with patients, even over video chat. This means that the ability to take full advantage of telehealth is contingent on access to broadband internet. In an Alabama Daily News article, leaders of a practice in a rural part of the state estimated that two-thirds of their patients lack an adequate device or internet connection for a virtual appointment. In addition, reporting by North Carolina Health News shows that a community health center serving rural parts of that state is offering creative solutions—such as parking lot appointments—to take advantage of wireless hot spots.
Although some interventions address the issue temporarily, for telehealth to be effective and narrow the treatment gap long term, policymakers and stakeholders will need to address the disparities that prevent access in some parts of the country.
As treatment programs and providers gather additional data on the effectiveness of telehealth approaches to treat people with OUD, policymakers should consider making the federal rules relaxed during the pandemic permanent. Improved access to SUD care—virtual or in person—remains integral to addressing substance misuse and the ongoing opioid crisis.
Beth Connolly is a project director and Leslie Paulson is an officer with The Pew Charitable Trusts’ substance use prevention and treatment initiative.