Updating Telehealth Policies Can Benefit Telehealth Opioid Treatment

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HERE IS HOW

During the pandemic, the forced adoption of telehealth has continued to help those struggling with opioid addiction living in rural areas, including many previously incarcerated, marginalized, homeless people, and their families. In the United States alone, a recent PEW Trusts’ study reported that 71,000 people died due to opioid overdose in the past year alone, while 1.6 million are grappling with opioid use disorder. In February of 2021, Mattson and colleagues were cited in the Centers for Disease Control (CDC) Morbidity and Mortality Weekly Report (MMWR) that “deaths involving synthetic opioids other than methadone, cocaine, and psychostimulants have increased in recent years.”1 The CDC also reported that “Over 81,000 drug overdose deaths occurred in the United States in the 12 months ending in May 2020, the highest number of overdose deaths ever recorded in a 12-month period, according to recent provisional data from the Centers for Disease Control and Prevention (CDC).”

While many attempts have been made to address the growing need, including telehealth-related legislative efforts, interest seems to be dwindling. Many states implemented telehealth opioid use disorder (OUD) treatment support and have seen positive results, but many private insurers have rolled back reimbursement for many telehealth services, including for OUD. State roll-backs for telehealth OUD treatment coverage are occurring despite the need for care and the many benefits of telehealth services for this population.

In response, research organizations have published reports urging lawmakers and Medicaid agencies to review their telehealth policies to ensure optimum goals are met to deliver care.  This article summarizes a few of the key points made in the PEW Trusts’ latest opioid report.

Reimbursement For Telehealth Opioid Treatment

Reimbursement for telehealth opioid treatment from private and public insurers typically allows for better services rendered. Medicaid programs and private payers who reimburse practitioners for providing Opioid Use Disorder (OUD) treatment in person often cover the same services provided via telehealth. A nationwide survey found that practitioners prescribed buprenorphine for opioid use disorder via telehealth without an in-person examination saw only 5% difficulty providing buprenorphine, the same percentage as in-person programs. For this reason, many clinicians feel that telehealth policies should include reimbursement from private payers and Medicaid when prescribing buprenorphine for opioid use disorder as it limits the burden of in-person visits. Moreover, it is noted that telehealth is efficiently replacing in-person care and therefore is seemingly the ideal course of action for the present and future.

Telehealth Policies Concerning Location Expansion For Telehealth Opioid Treatment

Often patients cannot receive telehealth services at home or conveniently located facilities as they are required to utilize services only offered at treatment centers or other sites that may require them to travel long distances. These areas can render difficult when patients lack means of transportation or if they need to tend to other responsibilities. Therefore, telehealth policies can be regulated to include opioid treatment services at more accessible locations, including the patient’s home, which is generally the preferred environment.

Studies indicate that patients can safely take buprenorphine for opioid use disorder in their home, much like in an in-office setting. The same notion can be applied to correctional facilities as telehealth opioid treatments are lacking in jails and prisons. This can be addressed, corrected, and applied adequately if states purchase telehealth equipment, hire staff, and fund their infrastructure within this setting via reimbursement through private and public insurers.

Permitting Telehealth Policies To Include Audio-Only Methods For Opioid Treatment

The pandemic has shown that audio-only technology is key as it has provided aid and attracted new patients who would have otherwise forgone opioid treatments. There is a call for telehealth policies to be reworked to have Medicaid reimburse audio-only methods for opioid treatments to assist those experiencing inequalities within different marginalized communities. Medicaid can also utilize phones to conduct counseling, medication guidance, and intake assessments, only serving benefit patients from all walks of life. See Telehealth.org’s previous article Audio-Only Telehealth: A Classic Solution to a Modern Crisis and Telephonic Telehealth Opioid Treatment Found Effective.

Barriers may be present in telehealth’s infrastructure, broadband access, and monitoring and development, so it is essential to consider all of these factors even with reimbursements provided. Since many drug overdoses are common and fatal, expanding telehealth’s policies to include opioid treatments is key. Readers are encouraged to contact their state governors and other related groups within their states to advocate for the expansion rather than the restriction of reimbursement for telehealth. Facts and 2-paragraph case summaries presented in a single-page format are most likely to be considered by busy lawmakers. Of course, concealing any potentially identifying information about patients is essential.

Bibliography

Mattson CL, Tanz LJ, Quinn K, Kariisa M, Patel P, Davis NL. Trends and Geographic Patterns in Drug and Synthetic Opioid Overdose Deaths — United States, 2013–2019. MMWR Morb Mortal Wkly Rep 2021;70:202–207. DOI: http://dx.doi.org/10.15585/mmwr.mm7006a4

Baldwin GT, Seth P, Noonan RK. Continued Increases in Overdose Deaths Related to Synthetic Opioids: Implications for Clinical Practice. JAMA. 2021;325(12):1151–1152. doi:10.1001/jama.2021.1169.