Despite the enormous unmet need for treatment of substance use disorders and the promise of telemedicine to fill some of the gaps in care, the tool remains woefully underused, according to research led by investigators from the Blavatnik Institute at Harvard Medical School.
The study, published in the December issue of Health Affairs, analyzed patterns of telemedicine use and showed that overall use remains low despite some increase in the use of this tool.
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In what is thought to be the first study of telemedicine for the treatment of substance use disorder, the researchers used insurance claims from 2010 to 2017 to identify characteristics of telehealth users and patterns of use.
Specifically, the analysis showed that the rate of telehealth visits for substance use disorder increased quickly during the study period: from 0.62 visits per 1,000 diagnosed (97 visits) in 2010, to 3.05 visits per 1,000 diagnosed (1,989 visits) in 2017.
Despite this increase, telehealth visits for substance use disorder remained extremely low, representing just 1.4 percent of telehealth visits for any health condition. The number of telehealth visits for substance use disorder accounted for only 0.1 percent of all substance use disorder visits.
The study also showed significant geographic variation in the use of telemedicine for substance use disorder. While per capita rates of telehealth for treatment were higher among rural residents, the vast majority of people receiving telecare were in urban areas.
Targeted interventions to increase access to telehealth in rural areas are needed to address the significant unmet need for substance use disorder treatment options outside urban areas, the researchers said.
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The researchers also found that telehealth treatment for substance use disorder is being used almost exclusively as a complement to in-person care rather than as a standalone treatment. In these cases, telehealth may ease access to follow-up care for some patients or provide access to a particular type of service that may be unavailable in their community.
There are a number of barriers that preclude the wider use of telehealth for substance use disorder, the researchers said. Important among them is the shortage of substance use disorder providers, particularly in rural areas.
Other barriers include regulatory and reimbursement hurdles, though that is slowly changing. While it's possible to do telehealth visits from just about anywhere with a fast internet connection, rules for reimbursement and restrictions on prescribing controlled substances, including those used for substance use disorder treatment, often require patients to come to a qualified facility like a clinic or a hospital which has a telehealth facility that they can use to meet remotely with a clinician at another location.
About 21 million Americans have a substance use disorder related to alcohol, opioids or other drugs, according to the 2016 National Survey on Drug Use and Health. Deaths from opioid overdose nearly quadrupled from 1999 to 2016, according to the U.S. Centers for Disease Control.
There are several treatment options for substance use disorder, including medications and psychotherapy or counseling, but fewer than one in five people struggling with the disorder receive treatment, the researchers said.