Telehealth Services for Individuals with Substance Use Disorder

Write-up by IRIS team member:  Eunsong Park

This research corner describes three articles focused on telehealth services for individuals with substance use disorder (SUD), especially opioid use disorder (OUD), during the COVID-19 pandemic.  All articles recognized that individuals with SUD had experienced difficulties to access treatments, and that COVID-19 has facilitated the implementation of telehealth service expansion in SUD treatment settings, just like in other health care settings.  In this research “round up” of relevant articles, I will examine perspectives of telehealth services from patients, clinicians, administrators, and other treatment facility personnel.   

Article 1: Sugarman and colleagues (2021) presented patients’ perceptions of telehealth services for outpatient treatment of SUD near Boston.  The majority of 53 patients were satisfied with the quality of telehealth care (86.2%) and noted that telehealth care met their needs as much as in-person visits (82%). More patients were satisfied with individual therapy (90%) and individual medication management (75%) than group therapy (58%).  The reasons why patients liked telehealth included accessibility from home (90%) and less travel time (83%).  The aspects of telehealth they didn’t like included feeling less connected to other group members (28%) and the service being interrupted at home or work (26%).   

Article 2: Aronowitz and colleagues (2021) shared their findings on experiences with telehealth services from interviewing 22 prescribers and other staff at outpatient OUD treatment programs providing buprenorphine in Philadelphia.  First, clinicians saw improvements in access to treatments for the patients who were deemed “stable” and less “stable” but wanted to (re)engage in medication treatment.  Second, clinicians found that some patients with technology barriers that either do not have a stable phone or internet, or do not feel comfortable using technology, experienced challenges in access to telehealth services.  Third, future use of telehealth is expected to be based in part on patient preferences and in part on clinician assessments of patient stability.   

Article 3: Molfenter and colleagues (2021) reported perspectives of SUD treatment providers on the future use of telehealth after COVID-19 through conducting an online survey with administrators and personnel at 457 SUD treatment and recovery organizations from 43 states.  According to survey results, the organizations have shown different rates of utilizing telephone-based and video-based modalities for different types of SUD treatment.  The three services with the highest frequency of telephone-based service use were screening & assessment/intake (84.6%), case management (84.3%), and regular outpatient treatment (83%). The three services with the highest frequency of video-based service use were regular outpatient treatment (80.3%), screen & assessment/intake (73%), and case management (68.8%).  Overall, organizations expected to use more telehealth services (both phone-based and video-based services) after COVID-19 compared to their pre-COVID-19 services. Organizations were 9% more likely to support implementing video-based services compared to phone-based services.  Organizations were 71% less likely to rate video-based services as easy to access compared to phone-based services.  

The three articles covered above indicate that patients, clinicians, and substance use treatment organizations viewed telehealth services positively, but there were some caveats.  These include concerns about patient stability, sense of connection, and technology barriers that patients may experience while using telehealth services.  One of the IRIS-funded projects, the Maryland Peer Advisory Council (MPAC), provides a warm-line call service to peers with lived experience with substance, mental and behavioral health recovery within the state of Maryland. During the call, peers receive telehealth support from a trained Peer Recovery Specialist.  Like other treatment and recovery organizations, MPAC uses both technology-based and in person approaches, which particularly with the impact of COVID-19 seems optimal to address the diverse needs of our communities.     

References:

Sugarman, Dawn E., Alisa B. Busch, R. Kathryn McHugh, Olivera J. Bogunovic, Catherine D. Trinh, Roger D. Weiss, and Shelly F. Greenfield. “Patients’ Perceptions of Telehealth Services for Outpatient Treatment of Substance Use Disorders during the COVID-19 Pandemic.” The American Journal on Addictions 30, no. 5 (2021): 445–52. https://doi.org/10.1111/ajad.13207 

Aronowitz, Shoshana V., Eden Engel-Rebitzer, Abby Dolan, Kehinde Oyekanmi, David Mandell, Zachary Meisel, Eugenia South, and Margaret Lowenstein. “Telehealth for Opioid Use Disorder Treatment in Low-Barrier Clinic Settings: An Exploration of Clinician and Staff Perspectives.” Harm Reduction Journal 18 (November 25, 2021): 119. https://doi.org/10.1186/s12954-021-00572-7 

Molfenter, Todd, Nancy Roget, Michael Chaple, Stephanie Behlman, Olivia Cody, Bryan Hartzler, Edward Johnson, Maureen Nichols, Patricia Stilen, and Sara Becker. “Use of Telehealth in Substance Use Disorder Services During and After COVID-19: Online Survey Study.” JMIR Mental Health 8, no. 2 (February 8, 2021): e25835. https://doi.org/10.2196/25835