Telehealth by phone and video proves a lifeline for veterans with opioid addiction

For folks with opioid habit, many hurdles stand in the best way of getting efficient remedy—and COVID-19 may have made it tougher.

However with widespread implementation of telehealth, a brand new research exhibits, extra persons are receiving remedy, even amid the pandemic.

The nationwide research appeared on the care obtained by veterans who obtained buprenorphine to deal with their opioid use dysfunction each earlier than and after the pandemic shifted care to telehealth visits in early 2020.

It exhibits that digital visits with habit care suppliers allowed many sufferers to remain on their treatment to help their restoration all through the primary yr of the pandemic.

It additionally exhibits an vital function for telephone-only visits for these sufferers. Audio visits far outpaced each video visits and in-person visits for all of 2020. And even by early 2021, telephone visits nonetheless accounted for half of all veterans’ buprenorphine-related visits every month, with video visits at 32% and in-person care at 17%.

On a month-to-month foundation, 14% extra veterans have been receiving buprenorphine care in February 2021 in contrast with March 2019. Throughout that very same time, the full variety of veterans receiving any kind of habit remedy dropped 6%.

The research is revealed within the American Journal of Psychiatry by a group from the College of Michigan and VA Ann Arbor Healthcare System. The lead writer is Allison Lin, M.D., M.S., an habit psychiatrist and researcher within the Dependancy Middle at Michigan Medication, U-M’s educational medical middle, and the VA Middle for Medical Administration Analysis.

Informing telehealth coverage

The brand new phone, video and in-person remedy knowledge may assist inform main coverage questions being debated proper now.

Policymakers are working to doubtlessly exchange non permanent pandemic-era emergency telehealth insurance policies for sufferers nationwide, not simply within the VA system. Earlier than the pandemic, audio-only visits have been usually not allowed and video visits to sufferers at residence have been usually not reimbursed.

Policymakers ought to think about proof fastidiously earlier than making remaining guidelines, says Lin.

“Telehealth for sufferers receiving buprenorphine for opioid use dysfunction was comparatively new within the VA nationwide earlier than the pandemic struck, and solely video was allowed. The speedy swap to digital visits for many sufferers stored folks from dropping out of care, and phone visits performed a key function,” she says. “Due to the VA’s nationwide affected person knowledge system, we’re in a position to present among the first understanding of telephone, video and in-person visits throughout the pre-pandemic and pandemic period.”

Telephone entry, she notes, could also be particularly vital for folks with opioid use dysfunction who usually lack secure housing, high-speed web or entry to a pc.

“Telephone visits might present flexibility to make it simpler to maintain folks engaged in care over time,” she says. “These are additionally usually among the sickest sufferers we take care of, who’ve among the highest danger for overdose. Retaining these sufferers in care is a serious precedence.”

Insurance policies that make it as simple as doable for them to stay with habit care may make a serious affect on their total outcomes, provides Lin, who’s a member of the U-M Institute for Healthcare Coverage and Innovation and the U-M Harm Prevention Middle.

“Anecdotally, some clinics have seen no-shows lower over the previous two years, as a result of we may do telephone or video,” she mentioned. “All through the pandemic, the idea has been that we now have to return to pre-COVID-19 standing. However this can be a case the place any makes an attempt to push folks again to in-person care if they do not need to go, or to ban digital visits, may need unintended results. If insurance policies do not enable flexibility and supply choices, we might lose folks, a few of whom have solely identified care through telephone or video.”

Subsequent steps

Along with this research, Lin notes, additional work is critically wanted to know affected person and clinician experiences and preferences, and to additional consider the standard of telehealth-delivered care.

“The purpose is to find out what high-quality care appears to be like like, each through telehealth and in-person, to tell requirements for the sphere, however that can take time,” she mentioned.

Within the meantime, efforts to enhance entry to buprenorphine care should proceed, she says.

“Dependancy is the one sickness we now have in all of medication the place the situation itself makes it onerous for folks to need to search remedy,” she notes. “However simply because we modified to telehealth does not imply we eliminated different boundaries to care. It is going to take extra to really get efficient take care of OUD to individuals who want it.”

Lin and her U-M colleague, habit psychologist and researcher Erin Bonar, Ph.D., are engaged on precisely that situation of their present analysis.

As an alternative of ready for sufferers to hunt habit care, their group is exploring methods to outreach to sufferers and supply remedy through telehealth. This goes past previous research which have left it as much as sufferers to make a name to get remedy.

Outcomes from their pilot research of this program have been very promising and now they’re testing this program in two full-scale randomized managed trials supported by the Nationwide Institutes of Well being.

“Dependancy care and analysis have usually centered on sufferers who’re treatment-seeking and already within the door. However that is a minority of these with substance use issues,” says Lin. “Now that we now have seen the ability of telehealth to help restoration, we have to attain extra of those that may gain advantage from care. We now have to make entry to habit care so much simpler and meet folks wherever they’re.”

Along with this effort, Lin labored with others to develop a free toolkit to help providers ensure that they provide high-quality buprenorphine care and different remedy for opioid use dysfunction. It is out there by way of the Providers Clinical Support System funded by the federal Substance Abuse and Psychological Well being Companies Administration. The current easing of federal guidelines for suppliers who want to prescribe buprenorphine may imply more providers can begin doing so.