Rx Summit Spotlight: Telemedicine Can Unlock Limited Access to Buprenorphine

The emergence of buprenorphine has revolutionized the treatment of opioid use disorders, but the option of receiving this medication remains elusive for many patients who live in remote, underserved communities. New and creative models of care will have to be established to expand desperately needed access to treatment for these individuals, says a University of Maryland physician who is involved in an innovative telemedicine initiative in the state.

At next month's National Rx Drug Abuse & Heroin Summit in Atlanta, Eric Weintraub, MD, will present a workshop session titled “Prescribing Buprenorphine Through Telemedicine: Practical and Regulatory Issues and Pilot Data.” Weintraub, an associate professor of psychiatry at the University of Maryland School of Medicine, will explain that while leaders of the initiative that targets six Maryland counties had to come up with a workaround to overcome regulatory barriers to delivering buprenorphine through telemedicine, those obstacles soon should be lifted at the federal level.

Prescribers technically must conduct an in-person evaluation of a patient before prescribing the highly regulated partial agonist medication, but a provision in the federal Comprehensive Addiction and Recovery Act (CARA) requires the establishment of a special registration that will allow for greater prescribing through telemedicine. Scheduled to be implemented by October, the registration should usher in more programs like the one in Maryland, which features several models for ongoing communication between physicians who are located in more populated areas of the state and the patient's counseling team at home.

“They all get counseling,” Weintraub tells Addiction Professional, referring to patients in the six counties scattered across the state. “They all have a support system within a clinic.”

He points out, however, that in even more remote communities across the country, residents may not have direct access to either prescribers or counseling support, which is why other new models of care are needed.

Encouraging outcomes

The Maryland counties participating in the telemedicine initiative are located in areas ranging from the Eastern Shore to the far western region of the state. Weintraub says that for some counties, the off-site buprenorphine prescriber has periodic team meetings with counseling staff, while in others the prescriber receives counseling notes to stay informed on patient progress.

About 125 patients are currently being served in the program, which has treated more than 500 individuals since its inception in 2015. Weintraub will share at his conference session some data that have been collected on 175 patients. The overall takeaway from the numbers: “These patients do as well as patients we would see face to face,” he says.

At the three-month mark, 60% of the patients remain in treatment, Weintraub says. He adds that not all of the patients who leave treatment should be labeled as failures, as some have legitimate reasons around work and family. Of those who are retained at three months, only 6% have tested positive for opioids, he says.

A Health Resources and Services Administration (HRSA) grant will allow the program to add a mobile van component to its services, Weintraub adds.

He says his April 23 session at the conference will speak to the importance of medication-assisted treatment more broadly, and then will address the serious shortage of providers and how efforts such as the Maryland initiative can be beneficial.

“The preferred option would be to get enough providers to do in-person treatment, so we wouldn't even need telemedicine,” he says. “Until that happens, this is an excellent way to expand access to treatment, and we've shown it can be effective.”

The Rx Drug Abuse & Heroin Summit, April 22-25 in Atlanta, is where solutions are formulated, stakeholders from Federal to family convene, and change begins. It is the annual gathering for stakeholders to discuss what's working in prevention and treatment. For more information, visit rx-summit.com