Since the rise of the pandemic and co-occurring spike in opioid overdoses, medication-assisted treatment (MAT), the standard of care for opioid use disorder, has been successfully delivered via telehealth. One large opioid outpatient treatment center, CODAC Behavioral Healthcare, in Rhode Island, began using telephone counseling with MAT early into the pandemic. CODAC, in conjunction with Brown University, has been studying the effectiveness of telephone counseling with MAT.
Telephonic Telehealth Opioid Treatment Satisfaction
At CODAC, MAT includes the use of medications such as methadone and buprenorphine with counseling. Though the data has not yet been published, the findings are very encouraging. Per Linda Hurley, president and CEO of CODAC, 247 patients and 41 counselors participated in a survey from August through October 2020. Some of the findings for telehealth opioid treatment include:
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- Satisfaction with telephone counseling was 92.3%
- 70.9% reported that telephone counseling was as effective as in-person treatment
- 16% of participants stated telephonic service was more helpful than in-person treatment
- 61.9% said that telephone counseling was as effective with recovery as in-person treatment.
- 19.3% stated telephonic services helped more with recovery than in-person treatment
Ms. Hurley also reported that telephone counseling appeared to be more effective in helping clients achieve their treatment goals.
The Cons of Telephonic Telehealth Opioid Treatment
The majority of clients and counselors found telephonic counseling to be a very positive experience and want to continue it post-pandemic. Some clients, however, indicated that privacy issues existed due to having sessions from home. Some reported a sense that sessions felt impersonal. Counselors also reported that telephonic counseling negatively impacted their workflow.
Why Continuing Data Collection is Needed
Ms. Hurley highlighted the importance of continuing to gather data on virtual care for clients with opioid use disorder because they often have comorbidities that interfere with their access to care, which is exacerbated during a crisis. Further data collection could have real impact on reimbursement for telephone and other forms of virtual counseling. For more information on reimbursement for telephone counseling click here.
Take-Home Medication Dosing Successful
In addition to studying the effectiveness of telephone counseling and MAT, CODAC and brown University have also been studying the impact of distribution of take-home doses of MAT medications to existing clients. Clients studied were receiving either 2 week or 28-day supplies of methadone or other MAT medications and were monitored/counseled either daily or weekly. Out of 160,000 bottles distributed only 1% of the medication was mishandled.
Assessing Client Appropriateness for Telephone Telehealth Opioid Treatment, MAT and Take Home Medication
The use of telehealth opioid treatment with MAT and take-home medications has greatly helped to limit client exposure to COVID-19. Not all clients, however, are appropriate for virtual counseling and medication management. New clients are assessed in person and medication distributed daily.
Per Allegra Schorr, president of the Coalition of Medication-Assisted Treatment Providers and Advocates of New York State, while established patients taking methadone may be able to stay stable, “its the harder to treat and less stable cases that should be looked at carefully.” A balance must be reached between two safety issues: potential exposure to COVID -19 versus the potential for abuse in the less stable client. Click here for more information on assessment/screening for telehealth appropriateness.
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