Telehealth for Addiction Treatment and Recovery

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Telehealth involves the use of technologies such as telephone-based services, videoconferencing, texting, smartphone applications and web-based tools to provide care over a distance without requiring patients to travel to a clinic or provider's office. For some, the term telemedicine is considered the clinical use of technology while telehealth refers to a more widespread approach that includes products or services aimed directly at consumers.

Telemedicine Visits for Substance Use Disorders

A study by Huskamp et al. (2018) found that by analyzing claims data from a large commercial insurer from 2010–2017, the number of telemedicine visits for substance use disorder increased quickly from 97 to 1,989. However, despite the rapid increase, these visits accounted for just 1.4 percent of telemedicine visits for any health condition over the period. Comparatively, telemental health visits increased from 2,039 to 54,175—and accounted for 34.5 percent of all telemedicine visits for any health condition in that same time period. The researchers conclude that much work still needs to be done to get more people using telehealth for addiction treatment.¹

Is Addiction Treatment Delivered by Telehealth Effective?

Lin et al. (2019) conducted a systematic review on interventions delivering substance use disorder (SUD) treatment by video conference that assessed clinical impacts on substance use, treatment retention, and acceptability and feasibility. Interventions were categorized by substances, including alcohol and opioids. Several of the studies suggest that telemedicine could be associated with improved treatment retention when compared to participants having to travel for in-person treatment. Despite some of the current limitations of the studies, the researchers conclude that telemedicine-delivered treatments are a promising alternative, especially when evidence-based treatments are not readily available. For specific treatment and substance use categories, particularly when treatment retention is the key outcome, it is also possible that telemedicine could result in greater treatment retention due to increased accessibility for patients.²

Results from a systematic review of 22 articles conducted in three regions (the United States, the European Union and Australia) indicate that telemedicine reduced alcohol consumption. Other common outcomes included reduced depression, increased patient satisfaction, increase in accessibility, increased quality of life and decreased cost. Interventions included mobile health, electronic health, telephone and two-way video.³

Yang et al. (2018) note that a prominent strategy proposed to ramp-up medication-assisted treatment (MAT) access is providing it via telemedicine. Telemedicine has the potential to increase access to MAT medicines and therapy that is done at the same time in underserved, remote rural areas by providing direct-to-patient or specialty consultation services remotely.⁴

Telemedicine can allow patients with opioid use disorder to stay in treatment and receive counseling to further their recovery. Through enhanced convenience, reduced travel time and cost savings, telemedicine offers additional benefits for patients, physicians and the greater health care system.⁴

Three pilot projects have demonstrated the clinical potential for prescribing buprenorphine via telemedicine.⁴

An initiative in Maryland provided buprenorphine to more than 300 rural Marylanders. A chart review by Weintraub et al. showed that 59 percent of patients remained in treatment after three months and 94 percent of those patients still engaged in treatment at three months no longer used opioids illicitly.

In a West Virginia pilot study by Zheng et al. (2017), a review of two years of clinic records revealed no significant statistical difference between face-to-face and telemedicine buprenorphine MAT programs across three outcomes: additional substance use, average time to achieve 30 and 90 consecutive days of abstinence and treatment retention rates at 90 and 365 days.

An Ontario, Canada, study by Eibl et al. (2017) demonstrated that one year of buprenorphine or methadone therapy via telemedicine was strongly correlated with improved physical and mental health and reduced illicit drug use, relapse, hospitalization, mortality and illegal activity.

Digital Tools to Support Recovery

Digital tools, such as smartphone applications or text messaging, are also used by substance use disorder treatment professionals to supplement individual treatment plans.⁵

Evidence for the effectiveness of digital recovery support services is limited.⁶ Research on one smartphone app found reduced risky drinking days and higher abstinence rates than usual care.⁷ Research on another mobile app showed reduced hazardous drinking days and drinks per day.⁸ And positive results have been attributed to texting interventions using mobile device apps.⁹

Telemedicine Methods of Interest in Addiction Treatment

A study by Molfenter et al. (2015) looked at which telemedicine services were of most interest for purchasers of addiction treatment in five states and one county (Iowa, Maryland, Massachusetts, Oklahoma, South Carolina and San Mateo County, California). The technologies that generated the greatest interest were videoconferencing and smartphone mobile apps. The primary benefits identified for videoconferencing were greater access to services for rural patients and greater access to physicians who could prescribe Suboxone® for opioid dependence. Smartphone mobile apps greatest benefit identified was the ability to reach individuals in treatment recovery outside the treatment setting.¹⁰

Conclusion

The chronic nature of substance use disorders calls for methods for clinicians to stay connected with patients over extended periods of time.10 Telemedicine can increase access to addiction treatment services by removing the barriers of geography and stigma.¹¹ Despite having great potential for assisting recovery and treating patients with substance use disorders, telemedicine is underutilized in addiction treatment centers.¹²