Increasing Access to SUD Treatment Through Telehealth

Telehealth provides flexibility that addresses barriers to substance use disorder (SUD) treatment, but more research on its efficacy is needed and providers want more training and technical assistance, according to a session presented at the Rx Drug Abuse & Heroin Summit.

In this Q&A, session presenter Tami Mark, PhD, MBA, discusses a study she recently completed on the use of telehealth to increase access to addiction treatment in California during the COVID-19 pandemic, and related issues covered during the session.

Dr. Mark is the Director of Behavioral Health Financing and Quality Improvement at RTI International, a nonprofit research institute. Her research focuses on improving the quality of mental health and addiction treatment. She presented “Telehealth Unlocked: Can It Improve Substance Use Disorder Treatment?” with Saira Haque, PhD, MHSA, FAMIA, Director, Data Interoperability and Clinical Informatics, at RTI.

Q: Can you review how the COVID-19 pandemic altered the availability of SUD via telehealth in California? 

A: Addiction treatment providers in California promptly adopted telehealth in March when the public health emergency was instituted. Although the California Department of Health Care Services allowed telehealth for Medicaid beneficiaries prior to the pandemic, most California counties had not gotten around to instituting that flexibility until COVID-19 hit.

Use of telehealth varied significantly by type of substance use disorder service. We surveyed specialty substance use disorder providers in California from June to July of 2020 and found that 97% had increased their used of telehealth for outpatient services and 77% had for group counseling, but only 17% did for buprenorphine prescriptions and 16% for medication management.

Q: There are many different types of SUD services. Has research shown that any particular types work best with telehealth?

A: Through a systematic literature review, we identified only a handful of rigorous studies of the effectiveness of telehealth for SUD, in contrast to mental health services, where there is a robust research base. SUD and mental health research finds that individual 1:1 counseling can be equally effective when provided via telehealth or in-person.

Q: What are the biggest benefits SUD treatment providers in California have seen from using telemedicine?

A: Providers in California reported that the biggest benefit was the ability to deliver addiction treatment during the pandemic. Patients may want to maintain the convenience of not having to take time off from work, find childcare, pay for bus fare, and travel long distances to get addiction treatment after the pandemic.  Reducing these logistical obstacles may improve engagement in addiction treatment. About a third of patients drop out of addiction treatment within the first month, therefore there is a significant need to find ways to keep patients engaged.

Providers found that telemedicine facilitated greater ability to treat individuals in the community. They also noted the benefits of being able to see patients in their home environment.

Q: What are the most significant barriers to using telehealth that SUD treatment providers face?

A: Three significant barriers are: (1) lack of research and knowledge about which types of SUD services and patients can benefit from telehealth delivery and at which points in their treatment; (2) lack of clinician training on how to effectively deliver care via telehealth; and (3) lack of patient access to broadband and smartphones.

Q: Are there any SUD services that you recommend not be delivered using telehealth?

A: There are too few studies on most types of SUD services to say definitively that a particular service should not be delivered via telehealth. Our surveys and interviews with SUD providers in California suggest that services that require collection of biomarkers or clinical observation, such as drug testing, are harder to effectively deliver via telehealth. Also, because positive social connections are so important to SUD treatment, there is skepticism that it can be effectively delivered without in-person interactions with other patients and clinicians.

Q: How do you expect access to telehealth for SUD treatment to change after the COVID-19 pandemic?

A: The genie is out of the bottle. Telehealth will be used much more frequently for SUD treatment than it was pre-pandemic. We need to establish learning health care systems to inform what is working via telehealth and what is not and to help providers effectively deliver addiction treatment via telehealth.