Telehealth for substance abuse growing quickly, but lags behind mental health usage
Telemedicine visits for substance abuse disorder, or tele-SUD, increased over twentyfold between 2010 and 2017 in a commercially insured population, according to a Health Affairs study issued this week. However, the final rate of the visits in 2017 was low, and much lower than the rate of telemedicine visits for mental health.
Telehealth for substance disorders is primarily to complement in-person care visits, and disproportionately used by those with severe SUD.
The report calls for increased use of tele-SUD to address the opioid epidemic, calling its low rates a "missed opportunity."
Telehealth use among the commercially insured is growing quickly, and substance abuse is no exception.
The number of tele-SUD visits increased from 97 in 2010 to 1,989 in 2017 in commercially insured people diagnosed with substance abuse disorder — a promising statistic that tele-SUD may be able to help treat addicts.
But tele-SUD visits accounted for just 1.4% of all telemedicine visits for any health condition over that timeframe.
"Tele-SUD could improve treatment engagement and outcomes by providing additional sources or types of SUD treatment that could help patients overcome transportation, distance, or stigma barriers," researchers wrote, stressing the potentiality of the practice to ameliorate the opioid crisis.
Fewer than one in five people with SUD receive treatment, often due to a shortage of providers in their area. And there are some large regulatory barriers for telemedicine to surmount before it can start to more fully fill in those gaps.
States usually require providers to be licensed in the state where the patient is located, restricting the ability of telehealth providers to operate across state lines. Some states require practitioners to have cared for the patient in-person before they're allowed to interact via telehealth. Reimbursement is also a factor. Medicare fee-for-service only pays for telemedicine if patients are located at a certain type of care facility.
The Trump administration seems to be willing to help telemedicine along. A recent HHS report on fostering choice and competition in healthcare included a whole section on deregulating telehealth. The report calls for states to consider interstate licenses for providers and modified reimbursement policies to foster telemedicine growth.
Legislation is also a factor, the Health Affairs report notes. The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 restricts the prescribing of controlled substances via telemedicine. Such controlled substances include buprenorphine, which experts call invaluable for weaning recovering addicts off opioids.
But a law signed in October will help, researchers say. The SUPPORT for Patients and Communities Act allows telemedicine clinicians to register with the U.S. Drug Enforcement Agency and then prescribe controlled substances to patients — without an in-person exam first.
The low rate of tele-SUD use "bolsters the need for legislation such as SUPPORT," the researchers write, to deregulate barriers to tele-SUD use.
The report, which analyzed deidentified claims data from almost two million people with SUD diagnoses in the OptumLabs Data Warehouse, identified three models of care. The most prevalent model suggested by the data was a physician assessing and prescribing SUD medication for a patient via telemedicine, while local clinicians provide counseling in person.
Tele-SUD was also commonly used to facilitate follow-up and support a patient’s recovery after initial inpatient or outpatient SUD treatment, suggesting tele-SUD on its own may not be enough to treat substance abuse disorder.
The report had mixed findings on tele-SUD’s efficacy in reaching traditionally underserved patients, especially in rural areas. Though it found the rates of use were higher among rural residents, the vast majority of patients lived in urban areas.
Additionally, tele-SUD was more likely to be found in communities with relatively higher median household incomes, meaning more access may not directly equate to helping underserved populations.
Most tele-SUD users were male (61.2%), under 40 years of age (54.8%) and more likely to have an opioid abuse disorder than any other SUD.
Follow Rebecca Pifer on Twitter