Telehealth opens addiction care, but poses challenges, study says

The rapid changes in regulations and guidance made during the novel coronavirus (COVID-19) response could help many more people get care for opioid use disorder and other addiction problems, according to new research by the University of Michigan Addiction Center and VA Ann Arbor Healthcare System and published in the journal JAMA Psychiatry.

The experts document the recent policy changes that have made it possible for more addiction care to take place through telemedicine, specifically video chats and even telephone calls. They also note the requirements for in-person visits for key addiction treatments that have been waived, though only temporarily, during COVID-19.

Yet despite the recent rapid progress, they say, it will take more changes to truly lower barriers that stand in the way of delivering evidence-based addiction care to more people via telemedicine. If that happens, more people with substance use disorders could have access to care such as medications, psychotherapy, and peer group support, they said, even in rural areas and other places where addiction specialists are scarce.

Some of the authors already used telehealth as part of their work even before the COVID-19 pandemic. Based on that experience, and on the intense shifts to virtual care in the past three months, they give specific recommendations for how to make telehealth for addiction a sustainable option for more providers and patients.

For example, relaxation of rules such as the Ryan Haight Act, which previously didn't allow prescribers to prescribe buprenorphine and other controlled addiction treatment medications to patients they had only seen virtually, have made a big difference. Additionally, so have changes in rules and guidance from the Substance Abuse and Mental Health Services Administration to make it easier for clinicians to communicate and care for patients with addiction via telemedicine. The same changes to Medicare and Medicaid telemedicine reimbursement rules that have helped move non-addiction care online this spring are helping addiction providers, too, the authors said.

The rapid move to virtual care has been a big switch for a field that has focused for so long on building interpersonal rapport between patient and provider, the researchers said, and also on in-person checks such as urine tests to make sure patients are adhering to their treatment and spot relapses early.

The authors recommend three key changes going forward:

• Development of treatment guidelines that include both in-person and telemedicine-based care for substance use disorders, and that provide guidance on urine toxicology practices and use of new ways to monitor treatment progress including self-monitoring apps and other practices.
• More work to increase the availability of buprenorphine via telemedicine, including by increasing the number of physicians who are trained to prescribe it and monitor patients taking it. This could especially help rural areas hit hard by the opioid epidemic. Lin and her colleagues currently lead regular training sessions to get new providers started with such prescribing, and offer ongoing support for prescribers.
• More help for people with substance use disorders who are also coping with other mental health conditions, and with the psychological and financial stress brought on by the COVID-19 pandemic. Online resources including group therapy online will be key, the authors said.

“In this moment when clinical care has been transformed because of real-world necessity, rather than evidence produced by research, it makes research on the effects of that transformation all the more urgent,” said  Allison Lewei Lin, MD, MSc, lead author and addiction psychiatrist, in a statement. “We need to understand to what extent we should be offering telemedicine even after COVID-19 has subsided.”

Editor's note: Click here for more information and ongoing COVID-19 updates for integrative healthcare professionals.