People with opioid use disorder (OUD) face numerous hurdles getting treatment, and COVID-19 could have been yet another stumbling-block. However, a recent study shows that the extensive rollout of telehealth services made treatment for OUD more accessible, with more people seeking treatment despite the pandemic. The study, which was published in the American Journal of Psychiatry, compared number of veterans treated with buprenorphine for their OUD before the emergence of COVID-19 and after the pandemic caused a shift to virtual telehealth visits at the beginning of 2020.
According to researchers, remote visits with healthcare practitioners providing treatment to patients with OUD allowed many veterans to continue receiving buprenorphine medication to facilitate their recovery during the pandemic. The study also highlights the important role that telephonic visits played in helping to support recovering patients.
During 2020, telephonic consultations far exceeded online video consultations and in-person consultations. By early 2021, telephonic visits still accounted for half of monthly veteran consultations, with video consultations and in-person consultations accounting for 32 percent and 17 percent respectively. According to the study, the availability of telehealth services bolstered the number of veterans receiving buprenorphine to facilitate their recovery from OUD by 14 percent by February 2021 compared to March 2019.
Crafting an Appropriate Telehealth Policy
Policymakers are currently debating whether to scrap temporary COVID-era telehealth policies for all patients (veterans and non-veterans alike). Reverting to pre-pandemic guidelines would mean that telephonic consultations would not be allowed in most circumstances. As a result, costs associated with video consultations would likely not be reimbursed. These findings could address many concerns related to telehealth policy and help shape the future of telehealth so that it continues to provide a valuable support mechanism for those who need it most.
According to lead author, Allison Lin, MD, MS—an addiction psychiatrist and researcher at the Addiction Center at Michigan Medicine, University of Michigan’s academic medical center, and the VA Center for Clinical Management Research—policymakers should carefully consider the findings before reversing temporary COVID-19 telehealth policies. New rules could ultimately have a negative impact on the health outcomes of people seeking help for opioid use disorder.
“Telehealth for patients receiving buprenorphine for opioid use disorder was relatively new in the VA nationwide before the pandemic struck, and only video was allowed. The rapid switch to virtual visits for most patients kept people from dropping out of care, and telephone visits played a key role,” Lin said. “Thanks to the VA’s national patient data system, we’re able to provide some of the first understanding of phone, video and in-person visits across the pre-pandemic and pandemic era.”
Telephonic access to medical care may be particularly game-changing for people with OUD, as many of these individuals do not have stable housing situations, which means no consistent access a computer or the Internet. Being able to use the phone for appointments removed a major barrier to access for a population of patients in great need, a barrier that has not been removed even as we return to a new normal phase of the pandemic. Flexibility keeps patients in care, reduced the risk of overdose, and encourages patients to be engaged in their care over the long-term.
It needs to be as easy as possible for people to seek help for their OUD and continue receiving the medication they need to help them recover fully, says Lin, who is a member of the U-M Institute for Healthcare Policy and Innovation and the U-M Injury Prevention Center. Health policies need to take heed of this to ensure the best overall health outcomes for these patients, she adds.
Phone and video appointments may reduce the percentage of no-shows, as some clinics found during the pandemic. While the original goal of the medical community was to return to pre-pandemic standards and practices, it is important for providers to remember that patients grew accustomed to the convenience of telehealth visits. In fact, many patients these days have only received care virtually. If receiving care is made contingent upon in-person visits, some patients may fall out of compliance with their treatment regimen. Others may stop seeking care altogether.
Future of Telehealth for Treatment of Substance Use Disorders
Lin points out that further research in needed to gain a better understanding of the experiences and preferences of both patients and healthcare practitioners, and to evaluate the quality of healthcare received via telehealth channels further. Best practices need to be identified so that providers can offer high-quality care regardless of whether a patient attends a telehealth visit or an in-person visit.
But in the meantime, we must continue to increase patient access to buprenorphine, says Lin. Because of the way addiction works, the people most in need of assistance are the least likely to seek treatment. The switch to telehealth removed one barrier to access appropriate care. However, other barriers exist. The medical community can’t rest on its laurels; rather, researchers need to continue to explore ways to improve OUD treatment and make it easy for patients to seek, obtain, and stick with the rehabilitation process.
Together with colleague Erin Bonar, an addiction psychologist and researcher at the University of Michigan, Lin is investigating this issue. They have received funding from the National Institutes of Health to study virtually delivered care for people with alcohol use disorders, and they are currently piloting the program. Rather than waiting for patients to take the initiative to seek medical treatment for their substance use, the duo is exploring an outreach service that targets the people not receiving care and offers them treatment and support for their substance use disorder via telehealth.
Traditionally, providers have had to wait until patients come to them before initiating addiction care. However, most people with substance use disorders are not yet treatment-seeking. Being able to use telehealth to initiate or maintain contact with the patient throughout the treatment process would enable providers to help more people. Meeting people where they are in their substance use journey is an important component to their success recovering from the disorder.
Lin has also helped develop the Telehealth for Opioid Use Disorder Toolkit: Guidance to Support High-Quality Care published by the Providers Clinical Support System. This free toolkit serves as a guide to healthcare providers to help improve the quality of care and treatment they provide patients with opioid use disorder via telehealth.