Telemedicine underused in treating addiction

Providers aren't using telemedicine enough for substance use disorder treatment, and researchers say the resource is a "missed opportunity" when drug overdose deaths continue to climb and access to care remains limited.

Telemedicine visits for substance use disorder jumped from 97 in 2010 to nearly 2,000 by 2017, according to an analysis published Monday in Health Affairs. But substance use disorder represented only 1% of all telemedicine visits in 2017, and they made up 0.1% of all substance use disorder treatment visits.

By contrast, patients diagnosed with a mental health disorder accounted for more than a third of all telemedicine visits in 2017.

Telemedicine growth in substance use treatment has been stymied by federal regulations that require prescribers of medication-assisted treatments like buprenorphine to see patients in-person first. That requirement can make it difficult for patients in areas with few or no clinicians certified to prescribe MAT to receive treatment. There is an exception that allows local clinicians to prescribe buprenorphine if they're supervised by another provider via telemedicine.

Lawmakers and the Trump administration want to encourage providers to use telemedicine for opioid abuse treatment. More than 20 million adults in 2014 had a substance use disorder during the previous year, but only 2.5 million received treatment, according to figures from the U.S. Substance Abuse and Mental Health Services Administration.

In September, Admiral Dr. Brett Giroir, assistant health secretary at HHS, posted a blog informing providers about materials available that could help clarify how they can use telemedicine to expand buprenorphine treatment.

Expanding telemedicine use for treating substance use disorder treatment was one of the priorities included in the massive Support for Patients and Communities Act, a large package of opioid-related bills that President Donald Trump signed in October. The law expanded Medicare coverage of telemedicine services for substance use disorder to beneficiaries in their homes and required the CMS to draft guidance for states on how they can use telemedicine within their Medicaid programs.

But researchers said the law won't make up for the disparity between the low supply of addiction medicine specialists and high demand for their services. More than 70,000 drug overdose deaths were reported in 2017, according to the Centers for Disease Control and Prevention. The opioid epidemic was a significant driver in lowering U.S. life expectancy for the second year in a row.