Telemedicine for SUD: Underused, but will it even help outcomes or reduce costs?

Abstract

Telemedicine for SUD: Underused, but will it even help outcomes or reduce costs? Substance use disorder (SUD) treatment by telemedicine — referred to as tele-SUD — is on the increase, but overall rates of use are still very low compared to the use of telemedicine for mental illness, researchers have found. Reporting in the December issue of Health Affairs, they note that the shortage of SUD treatment providers, especially in rural areas, is contributing to the treatment gap in the United States. However, there are regulatory and reimbursement barriers to tele-SUD, and federal and state lawmakers are considering ways to reduce these. The researchers used claims data for 2010–17 from Optum, a large commercial insurance company, and found that tele-SUD is mainly used to complement in-person care, and disproportionately by those with severe SUD. De-identified data from commercial and Medicare Advantage patients was used. Tele-SUD can be performed by using remote diagnosis, treatment, or both via videoconferencing. Many randomized trials have found telemedicine effective in treating mental illness, sometimes even better than in-person care, according to background information in the study, which is written by researchers from Harvard Medical School and RAND. For SUD, telemedicine “may facilitate access in areas with few SUD providers or for patients who lack transportation or have physical barriers,” the researchers write. In the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act, signed into law this fall, barriers to tele-SUD are addressed, which may help, such as eliminating the requirement in the Ryan Haight Act that patients prescribed buprenorphine (or other controlled substances) have a face-to-face visit first.