Telemedicine is now mainstream. Surprisingly, however, one area in which telemedicine has not been used to its fullest capability is drug addiction treatment. As you are aware, the country is in the midst of an addiction crisis.  The statistics are daunting:

• Drug overdose is the leading cause of accidental death in the US;
• From 2000 to 2015, more than half a million people died from drug overdoses;
• A majority of drug overdose deaths (six in ten) involve an opioid;
• Deaths from prescription opioids have more than quadrupled since 1999.
• More than 1,000 people are treated each day in emergency departments for not using opioids as prescribed;
• About 1 in 4 people who receive prescription opioids long term for non-cancer pain in primary care settings struggle with addiction; and
• Overdose rates were highest among people aged 25 to 54 years.

Adding to the woeful statistics are the fairly dismal rates of addiction recovery—assuming that such recovery services are even available. Relapse rates are over 50 percent for certain drugs, and higher for opioid addicts. According to one survey, almost 9 percent of the population needs treatment but only 1 percent actually receives it. The National Institute on Drug Abuse notes that effective substance abuse treatment combines treatment medications with behavioral therapy—and traditional treatment is limited by the availability of treatment professionals who often are not available outside of in-person care settings.

Telemedicine and Addiction Treatment

This is where telemedicine comes in.  As one observer noted, “because it removes barriers of time and distance, telemedicine offers great potential for enhancing treatment and recovery for people with substance and abuse disorders.”

Among other things, telemedicine allows:

• Rural patients to receive treatment in their own homes or at a local health care facility;
• Patients to continue care when released from a treatment facility;
• Individuals to participate in virtual group therapy;
• Flexibility in scheduling;
• Treatment to be provided at all times;
• Patients to avoid potential stigma from appearing at an addiction treatment center/provider; and
• Patient behavior and activity to be tracked and monitored.

Interestingly, a number of studies on the use of telemedicine in addiction treatment found no difference in patient satisfaction regarding care provided in-person or via telemedicine.  More broadly, other studies have shown the effectiveness of telemental health services, including one that showed providing telemental health services to patients in rural and underserved areas significantly reduced hospitalization rates.

The federal government has taken notice. For example, the USDA is financing five Distance Learning and Telemedicine grants to the tune of almost $1.4 million for the development virtual treatment programs for opioid addicts in rural central Appalachia. The FDA launched a Naloxone App Competition, inviting programmers, public health experts, clinicians and others to encourage innovation in developing low-cost, crowd-sourced mobile health apps connecting individuals overdosing with those able to provide Naloxone, a prescription drug that helps reverse some of the effects of opioid overdoses.  Intriguingly, the Surgeon General’s Report on Alcohol, Drugs, and Health notes that while the evidence base of technology-based treatment interventions is limited, these technologies are promising, and encourage more research into telemedicine-based delivery models.

States are also starting to recognize the viability of telemedicine in addiction treatment.  The National Governors Association, for example, announced late last year that Minnesota, South Dakota, and Virginia are participating in a learning lab focusing on addiction treatment via teleconsultation.

Challenges

Despite the promise of telemedicine in addiction treatment, some providers have raised some concerns, including how to properly assess nonverbal cues when communicating with patients by video, technical difficulties associated with the use of telemedicine, and the lack of adequate training regarding the use of telemedicine.  Providers are particularly concerned that virtual care services may make it more difficult to establish the kind of rapport necessary to make such services effective.  Some argue that in-person interactions allow people to reveal more about their thoughts and emotions.

Perhaps more challenging are the numerous legal and regulatory issues raised by telemedicine in the addiction context—such as verifying patient identity, follow-up care, privacy and security, treatment of minors, prescribing of controlled substances (the Ryan Haight Act), and reimbursement. Some of these issues are the province of state law which vary from state to state—leading to an inconsistent patchwork of laws and regulations making compliance difficult.  I will deal with these issues in a future post.

Ultimately, I believe that addiction treatment makes a fine use case for telemedicine. There are far too many people without adequate access to treatment services, and telemedicine provides a viable alternative to bridge that shortfall.  While operational and legal challenges exist, it is difficult to imagine meaningfully addressing the addiction crisis without broader use of telemedicine.