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The Opioid Crisis-can Telehealth play a role?

Published Monday, September 30, 2019
by Adrian Rawlinson, MD

Since 2010, lawmakers and drug manufacturers have tried a number of approaches to stem the tide of opioid abuse, from imposing harsher penalties on providers who over-prescribe prescription painkillers to changing the composition of prescription opioids to make them harder to use recreationally. In response to the crackdown, newer, more powerful and more dangerous synthetic opioids like fentanyl have increased in popularity, leading to record highs in opioid-related overdoses in the past three years.

Studies have shown that medication-assisted treatments (MATs) like methadone and suboxone programs can reduce an opioid user’s risk of death by as much as 50%. Unfortunately, many people with opioid use disorders (OUDs) have little to no access to these kinds of treatment programs — particularly in rural areas, where the need is highest. Medical providers and researchers are looking for new ways to tackle opioid addiction, and telemedicine might be the key to getting this epidemic under control. Here are some of the ways telehealth can help with the opioid crisis.

Lighter Provider Workloads

As noted above, individuals in rural areas struggle the most with overcoming opioid addiction. This is primarily due to the lack of access to treatment — it is estimated that less than ten percent of rural counties nationwide offer opioid treatment programs. But even in urban areas, the number of patients far outweighs the number of providers. As a result, the providers who can prescribe medication to treat opioid addiction are overworked, often resulting in long wait times for individuals seeking treatment.

Telemedicine allows those providers to see a greater number of patients in a larger area and eliminates some of the existing barriers to care.

Encourages Individuals to Seek Treatment

In 2011, researchers surveyed opioid users to find out why they hadn’t sought treatment. More than half (52%) gave one of the following reasons: either it was too difficult to find help, or they were worried someone would find out.

Telemedicine could make it easier for someone to start treatment for an OUD by offering individuals the opportunity to seek treatment from the privacy of their own home. More importantly, telemedicine could help alleviate some of the burden that would otherwise be unavoidable with an in-person visit. When it comes to addiction, even the slightest barrier to care can be enough to discourage someone from seeking treatment — even if they know they need help. Telemedicine has the ability to give opioid users fewer excuses to delay treatment, and that makes a world of difference.

Increased Access to Specialists

In most cases, addiction can’t be treated with medicine alone. For individuals with OUDs, a solid support network is a vital component of staying sober. Just as telemedicine offers increased access to prescribers, it also makes it easier for patients to connect with specialists like psychiatrists and addiction counselors. In addition, telemedicine patients have the opportunity to connect with other opioid abuse patients by participating in group therapy sessions. Studies have shown that feelings of loneliness or isolation can trigger a relapse, and telemedicine could help eliminate some of the perceived distance between the individual and their support system. Knowing they’re not alone can sometimes be enough to help an individual maintain their sobriety.

Reduced Stress for Patients

For patients battling addiction, stress should be avoided as much as possible — studies have shown that stress is a key trigger for relapse. Ironically, for some individuals, that stress can be caused by one of the people helping them maintain sobriety: their medical provider. Even for someone not suffering from addiction, doctor’s visits can be stressful; fortunately, telemedicine allows providers to give their patients the care they need while also minimizing disruption to the patient’s daily routine. And when it comes to addiction, the ease of use that telemedicine offers could mean the difference between sobriety and relapse.

As Effective as In-Person Treatment

A common misconception is that telemedicine doesn’t allow for the same level of personal connection between patient and provider. Developing that connection is important in any medical specialty, but it’s an especially vital part of achieving positive outcomes in patients with OUDs. As it turns out, however, telemedicine MATs are just as successful as their in-person counterparts. A 2017 study found that face-to-face and virtual MAT patients had the same rates of additional substance use, averaged the same time to achieve 30 and 90 consecutive days of abstinence, and had the same treatment retention rates at 90 and 365 days.

It’s clear that telemedicine can help combat the opioid crisis, so why haven’t more providers adopted this approach to treatment? Unfortunately, just as patients face a number of barriers to receiving care, providers face a number of barriers to administering it.

Medications like buprenorphine (Suboxone) have proven to be incredibly effective in treating opioid use disorders. In France, all registered medical doctors are allowed to prescribe buprenorphine as part of their normal practice; the increased access to buprenorphine has been credited with a 79% decrease in opioid overdoses since the rule took effect in 1995.

In the United States, however, medication-assisted treatments for opioid abuse are highly regulated. The Drug Addiction Treatment Act (DATA) of 2000 requires providers to obtain a special “X waiver” before they can legally prescribe medications like buprenorphine, even though buprenorphine has a lower risk profile than insulin and acetaminophen (both of which can be prescribed freely).

In order to receive this X waiver, providers are required to undergo anywhere from 8 (for physicians) to 24 (for PAs and NPs) hours of training — time that many providers can’t afford to spend away from their practice. This, in turn, has led to a huge shortfall in the number of providers who can help patients with OUDs: a 2011 study found that 43% of counties in America have no providers who can prescribe suboxone, and only 5% of all providers nationwide have obtained their X waiver.

For the relative few providers who have obtained an X waiver, the challenges don’t end there: Telemedicine providers can only prescribe buprenorphine if they have first conducted an in-person examination of the patient. This additional restriction, though well-intentioned, can prevent opioid users in rural areas — many of whom live tens or even hundreds of miles away from the nearest substance abuse provider — from receiving treatment. There is hope, however: earlier this month, Sens. Maggie Hassan (D-NH) and Lisa Murkowski (R-AK) introduced the Mainstreaming Addiction Treatment (MAT) Act, which would lift the requirement of an in-person examination before beginning MAT for opioid abuse via telemedicine.

The opioid crisis in America shows no signs of slowing down, which makes it clear that we need to approach this problem in a new way. Telemedicine addresses the biggest challenges of our current approach, such as limited access for providers and patients, too many barriers to care for opioid users, and opioid users’ reticence to seek treatment due of privacy concerns. If we want to bring an end to the opioid epidemic, telemedicine needs to play a central role.