Examining the Role of Telehealth in the Treatment of Substance Use Disorders

Providers and patients indicate that telehealth and substance use disorder treatment are priority issues.

With Election Day now behind us and Congress returning, the switch to the new legislative season, both federal and state, has begun. Looking ahead, we expect to see continued discussions surrounding both telehealth and substance use disorder treatment – and recent reports indicate that the two might work together better than one might expect!

A new study released by the Journal of the American Medical Association (JAMA) determined that virtual care during the pandemic both reduced individuals’ risk of overdose, as well as increased the use of medication-assisted treatment. 

The biggest way that telehealth can impact substance use disorder treatment is honestly simple: by expanding access. Individuals are often unwilling or unable to seek substance use disorder treatment for the same reasons any individual can find it difficult to access healthcare: transportation issues, travel time to an office, lack of paid time off, or physical health constraints. 

What is different about substance use disorders, however, is that telehealth also helps mitigate the stigma and shame surrounding the issue – many patients may find that a telehealth appointment is much more comfortable than being seen in an office. There has also historically been a shortage of providers offering necessary treatment, and telehealth has offered an extended reach for the providers that do.

But doctors and advocates alike note that there can also be unique challenges to providing substance use disorder treatment via telehealth, and that there may be a different model lawmakers should consider.

While treating substance use disorders virtually comes with the typical worries about providers missing body-language and nonverbal cues, as well as decreasing patient accountability, one of the specific risks of using telehealth to treat these disorders is the isolation it may bring. 

Whether particularly enjoyable for the patient or not, there is a social aspect of coming into a doctor’s office or attending an in-person treatment group or group therapy. Additionally, the same stigma and shame that might make a patient more comfortable with virtual treatment can at the same time be a risk factor for patients not able to speak candidly if someone else is in the home with them during the appointment.

Many acknowledge that telehealth certainly has its time and place; when the results of the JAMA study came out, the American Telemedicine Association noted that this was “a strong signal to policymakers that telehealth can and should be a permanent part of healthcare delivery.” And indeed, a recent nationwide physician survey found that 85 percent of respondents were in favor of making telehealth permanent for the treatment of opioid use disorder, with 68 percent strongly in favor. 

But it might be better to look at both telehealth and in-office visits as tools in the provider’s belt, rather than an all-encompassing solution, especially for issues as complex as substance use disorder. Providers can pick and choose which tool (or combination of tools) works best for each patient’s situation. Taking this idea, lawmakers are being encouraged to consider a hybrid model of treatment going forward.

As legislators gear up for busy terms in the coming months, they will need to consider how best to support healthcare for this vulnerable population –  and remember that as a Board member of the American Telehealth Association stated recently when speaking on the subject, “laws often constitute a bridge from where our society is, to where we want it to go.” 

Many providers and patients alike have indicated that telehealth and substance use disorder treatment are priority issues for them – so now it’s up to legislators to craft the bridge to that reality.