Changes Urged to Facilitate Telehealth in Treatment of Patients With Substance Use Disorders

Telehealth urgently needs to be adapted for the treatment of people with substance use disorders (SUDs) in light of the global COVID-19 pandemic, wrote Lewei (Allison) Lin, M.D., M.S., of the Veteran Affairs Center for Clinical Management Research, in Ann Arbor, Mich., and colleagues in an article in JAMA Psychiatry.

Relaxation of regulations in response to the pandemic has made telemedicine more accessible, but “compared with mental health, adoption of telehealth for SUDs has been limited because SUD treatment often relies on frequent visits, intense monitoring through urine toxicology, and other practices that pose additional barriers,” Lin and colleagues wrote.

They urged the following steps to help leverage telemedicine in the treatment of patients with SUDs:

• Develop practice guidelines for telehealth-delivered SUD treatment. Overall guidelines for patient-centered, evidence-based care that incorporate some specific considerations for telehealth treatment of patients with SUDs are needed. Pertinent issues include how and how often urine toxicology screens should be obtained and coordination of care for patients with complex disorders.
• Facilitate prescription of buprenorphine through telemedicine. Buprenorphine is a life-saving treatment, but there are not enough prescribers. To attract and train clinicians to deliver care via telehealth to patients taking buprenorphine, greater efforts should be made to increase awareness of telehealth technology and infrastructure, billing and reimbursement policies, changes in federal- and state-level regulations, and strategies to encourage adoption by clinics.
• Incorporate psychosocial treatments into telemedicine. The stress and uncertainty brought on by COVID-19 emphasize the importance of patients having access to psychosocial resources, including psychotherapy, case management, crisis support, and community supports. Making resources accessible online and adapting evidence-based psychotherapy treatments to telehealth is key and would also support care after COVID-19.

“As we work fervently toward addressing the COVID-19 pandemic, we must also continue delivering ongoing treatment for patients, especially for those whom treatment disruptions may result in equally dire consequences,” Lin and colleagues wrote. “Telehealth can uniquely address capacity shortages, but much work is needed to support large-scale dissemination and adoption.”

(Image: iStock/Poike)

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