Virtual is Now Reality: Telehealth to Deliver Care for Substance Use Disorders

Models of care for substance use disorder (SUD) treatment have traditionally required face-to-face visits, since individuals receive a broad range of services including individual psychotherapy, group therapy, urine drug screens, laboratory testing, dispensation of Medications for Opioid Use Disorder (MOUD), and prescriptions for psychotropic or other medications. However, during the COVID-19 pandemic, telehealth became a more widely used method of delivering healthcare, including for SUD treatment. While the pandemic posed respiratory health concerns to all, individuals with a SUD were additionally vulnerable when attempting to access life-saving medications. An enforcement waiver of both federal and state telehealth rules during the COVID-19 public health emergency facilitated the use of ongoing telehealth, and allowed for previously prohibited practices in SUD treatment (i.e. first-dose prescribing of controlled substances without a face-to-face physical exam, periodic urine drug screens, etc). While this improved access to care for some, barriers and challenges to providing care via telehealth have remained.[1] Many scholars have noted that the implementation of telehealth potentially marginalizes patients from low socioeconomic status due to a possible lack of resources.[2] Despite this, however, the use of telehealth represents an important vehicle for achieving harm reduction goals for individuals with SUD. Given the shifting landscape of healthcare delivery, telehealth will remain integral and essential for SUD treatment in the future. During this session, we will explore the advantages and challenges associated with utilizing telehealth for the treatment of substance use disorders. Because of the socioeconomic complexities associated with SUD treatment, these patients often face unique disadvantages that require innovative approaches and extra consideration. Telehealth increases access to care by reducing barriers (e.g. transportation, time, stigma, childcare, etc.) which are especially important in this patient population.[3] We will discuss the “lessons learned” in our collective experience providing telepsychiatry in the treatment of other populations that we have now applied to the treatment of SUD. We will also share recently analyzed data which suggest a positive impact of telehealth upon engagement and treatment retention from our community mental health agency. During this session, we will also review the federal and some state telehealth guidelines and the changes that have occurred as a result of the pandemic, as well as discuss potential future directions.[4, 5] We will provide participants with case examples highlighting the challenges associated with telehealth for SUDs, including barriers faced by marginalized individuals. We will utilize active learning including audience polling, brief small-group discussions, and a question-answer portion at the conclusion of our session.