Telemedicine goes untapped for treating substance use disorders

As the country continues to struggle with a nationwide opioid epidemic, telemedicine could be an effective tool for treating patients with substance use disorders but the technology is going untapped.

Researchers from the Blavatnik Institute at Harvard Medical School analyzed insurance claims from 2010 to 2017 from a large commercial insurer, revealing that overall use of telemedicine for the treatment of substance use disorder remains dismally low—accounting for only 1.4 percent of telehealth visits for any health condition.

In addition, the number of telemedicine visits for substance use disorder accounted for just 0.1 percent of all substance use disorder visits.

“The low rates of telehealth visits for substance use disorder that we found represent a missed opportunity to get people the help they need, especially in the context of the ongoing opioid epidemic,” says Haiden Huskamp, professor of healthcare policy at Harvard Medical School.

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About 21 million Americans have a substance use disorder (SUD), according to the 2016 National Survey on Drug Use and Health. However, a small proportion of people with a SUD receive treatment, in part because of a shortage of SUD treatment providers, particularly in rural areas of the United States.

“Many experts believe that mental health conditions and substance use disorders may be particularly well-suited to telemedicine because their treatment doesn’t require an in-person exam,” says Huskamp. “I think more and more providers are getting interested in delivering telemedicine for these conditions, in part because they view it as a way to expand access and possibly improve engagement in treatment for these conditions where access is a real problem.”

Nonetheless, researchers point out that while it’s possible to conduct telehealth visits from practically any location with a fast internet connection, reimbursement rules and restrictions on prescribing controlled substances—including those used for substance use disorder treatment—often require patients to come to a qualified facility that has a telemedicine facility that they can use to meet remotely with a clinician at another location.

“Telemedicine could be a means of expanding access to treatment,” state the authors of the Harvard study, published in the December issue of Health Affairs. “However, several key regulatory and reimbursement barriers to greater use of telemedicine for SUD (tele-SUD) exist, and both Congress and the states are considering or have recently passed legislation to address them.”

The SUPPORT for Patients and Communities Act, opioid legislation passed by the House and Senate and signed into law by President Trump in October, expands the use of telehealth services for the treatment of substance use disorders.

“As tele-SUD becomes more available, it will be important to monitor closely which tele-SUD delivery models are being used and their impact on access and outcomes,” conclude the study’s authors.

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