Telehealth may be ‘game-changer’ for addiction treatment

Telehealth may bolster access, initiation and retention related to addiction treatment, but more research is needed, according to a study published in Psychiatric Services.

“COVID-19 was like turning on a light switch for telehealth,” Tami L. Mark, PhD, MBA, senior director at RTI International in Maryland, said in a press briefing hosted by the American Psychiatric Association. “Before the COVID-19 public health emergency and stay-at-home order that the government of California issued in March 2020, only about one in four addiction services providers in California offered any type of telehealth. By July 2020, almost 100% were offering telehealth for one-on-one counseling, and many were offering telehealth for other types of addiction services.”

Mark noted that the switch to telehealth was made possible by a relaxing of federal, state and county regulations that had previously constrained its use. As an example, she pointed to the DEA no longer requiring patients see a clinician in person before being started on buprenorphine for opioid use disorder.

In the current study, Mark and colleagues aimed to examine the research evidence on the efficacy substance use disorder treatment delivered via telehealth and providers’ experience with telehealth during the pandemic. Specifically, they sought to determine whether this evidence would support continued telehealth use following the pandemic and under what circumstances if it did.

The researchers obtained data from a literature review on telehealth efficacy in substance use disorder treatment, responses to an online survey in 2020 from 100 addiction treatment providers in California and interviews with 30 California treatment providers and other stakeholders. They identified eight studies that compared telehealth-delivered addiction treatment with in-person treatment.

Results from seven studies suggested telehealth treatment matched but did not surpass the effectiveness of in-person treatment for retention, therapeutic alliance and substance use. A Canadian study suggested telehealth facilitated methadone prescribing and increased retention.

Survey results from the California addiction providers showed they reported more than 50% of their patients received telehealth treatment for intensive outpatient treatment, individual counseling, group counseling and intake assessment. These providers reported the highest level of confidence in individual counseling via telehealth being as effective as in-person individual counseling but were less confident regarding the relative effectiveness of telehealth-delivered medication management, group counseling and intake assessments.

“Telehealth might be a game-changer for addiction treatment,” Mark said. “Getting individuals to enter addiction treatment and stay in treatment has been a longstanding problem.”

According to Mark, more research is needed to confirm the benefits of telehealth and under what conditions it is best used.

“Providers seem to be moving to a hybrid approach, where telehealth is used for some patients and some services but not others,” she said. “We need more research to determine to which services, patients and circumstances telehealth is bested suited.”