The Role of Telehealth in Helping to Address the Opioid Crisis

The opioid crisis has been recognized as one of the more serious issues gripping the US.  The CDC’s statistics are alarming.  The majority of drug overdose deaths (more than 6 out of 10) are opioid-related.  The number of overdose deaths involving opioids quadrupled since 1999.   Every day, an average of 91 Americans die from an opioid overdose.

Opioid-related cases are flooding hospitals.  An AHRQ brief indicated that the national rate of opioid-related inpatient stays increased 64.1% and the national rate of opioid-related emergency department (ED) visits increased 99.4% between 2005-2014.

Rural areas are particularly impacted by the crisis.  These areas suffer from high rates of unemployment and poverty while also relying on manual labor jobs which can cause chronic pain.   In 2016, then-secretary of the USDA Tom Vilsack envisioned virtual care as part of the answer to addressing this crisis for rural America.  According to Vilsack, “addiction treatment is often out of reach for many in rural America,” and “expanding access to telemedicine is an important step towards making sure rural communities have the tools they need to fight the opioid epidemic.” “

Virtual care can provide rural patients with access to the treatment they need while saving lives and optimizing available resources.  Wells House, in rural Maryland, was recently recognized by the Robert Wood Johnson Foundation (RWJF) for using technology to provide patients with more convenient and timely access to treatment.  When Wells House realized it needed to have a regular clinician to provide specific, evidence-based opioid treatment, it pursued a new delivery method for physicians to provide treatment remotely.  According to the RWJF, the initial idea came from Eric Weintraub, MD, director of substance abuse services at University of Maryland School of Medicine (UMSOM). Wells House had sought out his help in prescribing and managing buprenorphine treatment for clients with opioid disorders.  However, when Dr. Weintraub experienced challenges with frequent trips to Wells House from Baltimore, he turned to technology to help.   “It was a no-brainer,” Weintraub said. “Medication-assisted treatment is the gold standard for opioid addiction, and we have learned that telemedicine is as effective in most places as face-to-face care, so why not put the two together?”

The original pilot linked UMSOM physicians with Wells House patients remotely and provided treatment to 150 people in the first year.  A chart review showed that 60% were still in treatment after three months and 94% were free of illegal opioid use. “The results are very consistent and comparable to what you would find with face-to-face treatment,” said Seth Himelhoch, MD, professor of psychiatry at UMSOM, one of Dr. Weintraub’s partners in the pilot program.

The National Committee for Quality Assurance (NCQA) is updating its Healthcare Effectiveness Data and Information Set (HEDIS) scores for 2018 to include telehealth and to combat addiction risks associated with opioid use.  The NCQA is adding telehealth as a treatment option for alcohol and other drug abuse or dependence treatment.

Given their size, scope and service to their communities, rural hospitals and treatment centers have unique challenges in delivering health care.  Virtual care is being embraced by rural healthcare facilities as administrators and providers recognize how the video delivery of healthcare can transform their ability to serve their far-reaching residents.

The use of technology can “drive” better care coordination and immediate access to specialists – regardless of the distance between providers and patients – thus improving care quality and patient outcomes in rural communities.   Virtual care can transform the reach and resonance of a facility where distances between providers and patients are great while access to specialists is limited.

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