From remote patient monitoring to teletherapy, minor medical visits and more, we’ve seen the versatility in which telehealth can be used across health care systems. And it became a saving grace for treatment and recovery for people with substance use disorders, especially during the pandemic.
According to the CDC, 13% of Americans reported starting or increasing substance use as a way of coping with stress related to COVID-19, and overdoses spiked 18% nationwide since the onset of the pandemic according to a reporting tool called ODMAP.
As telehealth became more available and a common practice during social distancing mandates, providers, therapists and community-based groups like Narcotics Anonymous began to increasingly use telehealth for recovery and treatment plans.
Earlier this summer, the White House Office of National Drug Control Policy released a report that reviewed the use of telehealth related to substance use disorder treatments over the last few years. It also analyzed current laws and policies regarding telehealth services and made recommendations to ensure that telehealth for substance use disorder – and in general – is here to stay.
Here are a few takeaways that highlight key findings and recommendations made in the report.
Benefits, uses of telehealth for substance use disorder care
Telehealth increases access to health care for vulnerable populations, like those with limited mobility or experiencing social anxiety. It’s often a more affordable option for individuals who may not have access to health care because of financial circumstances and is a more accessible option for individuals who might not have access to transportation for an in-person visit. We’ve also heard from industry professionals that telehealth has been a solution for substance use disorder patients who need access to care but are too embarrassed to seek local support in a small town where “everyone knows everyone.”
For behavioral health professionals, telehealth has been a way to decrease the risk of exposure to illness, an increased concern since COVID-19. It also has become an opportunity to grow their practice by reaching patients beyond their community. For residents in counseling and other recent graduates pursuing licensure, virtual telementoring and supervised telehealth visits have become a way to help meet licensure requirements.
According to the report, the four most common modes for treatment as of 2021 include telephone-based recovery support, telephone-based therapy, video-based therapy, and asynchronous web-based assessments, which make up about 45% of substance use disorder-related telehealth services.
Needs to help sustain the future of Telehealth
While telehealth has been a solution for both individuals and behavioral health professionals within the realm of substance use disorder and beyond, providers, institutions and industry organizations are calling on state and federal governments to help sustain the future of telehealth. The report calls out four areas that should be addressed.
- Federal support of mutual recognition and reciprocity of state licenses.
Rather than states enacting individual medical compacts that allow providers to practice in multiple states, the report recommends the federal government consider legislative and administrative proposals that increase opportunities that permit licensed professionals to provide telehealth service to out-of-state patients.
- Permanently enact and expand PHE telehealth regulatory changes.
Under the CARES Act of 2020, Congress permitted a waiver that would allow beneficiaries to be reimbursed when telehealth is conducted outside of a qualified originating site. It is recommended that Congress act to make this waiver permanent as well as make permanent the substance use disorder treatment and recovery changes that have implemented. Those changes include authorizing qualified practitioners to prescribe controlled substances without conducting an in-person evaluation first.
- Increase funding for internet access, mobile app and assistive telehealth services.
The Federal Trade Commission estimates that more than 21 million Americans still do not have access to fixed broadband internet services, reinforcing inequities when it comes to accessing care.
The American Rescue Plan recently enacted by Congress aims to help expand high-speed internet access, but the report recommends that more private companies and organizations consider funding projects that will help to provide access to the internet.
- Consider privacy and ethical implications of telehealth use.
As telehealth use grows, so do legal considerations and areas of the law that are impacted by virtual care. During the COVID-19 emergency, HIPAA requirements while engaging patients via telehealth were waived, and providers had the autonomy to use non-HIPAA compliant tools and applications to see patients virtually. While many in the substance use disorder field recommend that temporary rules to remain, confidentiality and ethics must be considered. Even so, data is lacking and more clinical research on the ethical implications of telehealth use is needed to inform future policy.
As part of VTN’s Equity & Telehealth series, many of these legal recommendations have been a common theme when asking providers, clinics and practices what the future of telehealth looks like. We heard from thousands of licensed providers in Virginia who indicated a need for better internet (70%) and policy changes to reimbursement (59%) in order to effectively continue offering virtual alternatives to care.