3 Ways to Promote Telehealth During COVID-19 for Patients With Drug, Alcohol Addiction

Telehealth use has exploded since March, when the nation went into lockdown because of COVID-19. Experts are predicting that remote visits are likely to get woven into the routines of American healthcare delivery when the pandemic eases up, although how fully will depend on payment and regulations. The proposed home health care rule that CMS put out last week could be a sign of things to come. If adopted, the rule would make permanent changes introduced as part of the COVID-19 public health emergency: telehealth visits could be part of home health care plan although they can't replace an in-person visit and won't be paid for like one.

One area where telehealth seems an obvious solution—treatment for patients with drug or alcohol addiction—still needs work, say authors of a commentary published Wednesday in JAMA Psychiatry. Authors from the University of Michigan—Lewei Lin, M.D.,M.S.; Anne C. Fernandez, Ph.D.; and Erin E. Bonar, Ph.D.—say that while legal and reimbursement barriers to telehealth have come down, doctors still lack guidance on how to serve these patients with electronic visits. They note that “telehealth” can mean different things, ranging from full-on from video conferencing to cellphone texts on.

Patients with substance abuse disorders, who may include up to 7.8% of American adults, have distinct needs that can be hard to meet with remote visits, they note. How can clinics obtain urine screens? And will providers develop “therapeutic rapport” with patients in a remote visit?

These hurdles must be overcome, they say, because patients with addictions need more help than ever. COVID-19 creates “an unprecedented, unanticipated urgency and need” for services. Here are three of their recommendations for telehealth and treatmennt of people with substance abuse disorders:

• Create treatment guidelines. “Most SUD treatment has relied on fairly intensive monitoring and treatment,” they write, but COVID-19 creates the need for alternatives, which will be useful after the pandemic. The field needs evidence-based guidelines that outline the frequency and means for obtaining toxicology screens, which could involve tools such as “apps, transdermal devices, and photo verification of mailed biological tests.”

• Find new ways to deliver life-saving medications. Too few people were qualified to prescribe buprenorphine for opioid use disorder before the pandemic, and the easing of regulatory and reimbursement hurdles that have allowed telehealth to flourish must extend to this area, too. Rural areas have particularly high need, but research is needed on “how we overcome limited infrastructure and patient acceptability,” the authors say. Studies are also needed to learn which forms of telehealth work best.

• Add services, such as online group therapy. Many who live with addiction have other mental health disorders, and they need additional treatment, case management and community support services. More work is needed to address privacy issues when delivering care, however.

Most of all, the authors say, regulators must end barriers to telehealth for good. “Lifting of restrictions during COVID-19 is helpful, but many of these guidelines pertain to care only under the current public health emergency,” they write. “For lasting improvements to occur in treatment access, we need to make these changes permanent.”