by Alison Knopf
There is great interest in telehealth in all of health care, including treatment for opioid use disorder (OUD). One of the trickiest aspects of telehealth, however, is that the delivery of medication involves very concrete mechanical requirements. You can’t send a medication to a patient by video. In the case of methadone, and, to a lesser extent, buprenorphine, the chain of custody of the medication is heavily regulated by law enforcement.
But while medication must be dispensed to patients directly, other aspects of treatment could–if regulators allow–be done remotely, enabling expanded access, especially in rural areas. This would also surmount many of the NIMBY (Not In My Back Yard) problems associated with siting brick-and-mortar programs. And buying mobile vans is less expensive than building an entire new facility.
The next step in bringing telehealth to OUD treatment is for the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop guidance documents for opioid treatment programs (OTPs) on how to use telehealth and telemedicine in the OTP structure, Mark Parrino, MPA, president of the American Association for the Treatment of Opioid Dependence (AATOD), told AT Forum. And AATOD needs to play a role in this development, so that OTPs are encouraged to use these services, and understand how to move forward.
The use of telehealth services would work in conjunction with satellite medication units. There are some operating satellite medication units in the U.S., but the expansion of such entities to hub OTPs would expand the reach of the programs in rural and suburban areas of the country.
The CODAC Experience
CODAC Behavioral Healthcare, a Rhode Island–based OTP, is implementing a telehealth project for buprenorphine. With a $372,597 contract won this summer, the program will create a rapid crisis-response system linking high-risk populations with buprenorphine.
Linda E. Hurley, president and CEO of CODAC, explains that patients at the Thundermist federally qualified health center (FQHC) needing immediate access to medication-assisted treatment (MAT) will get it. There is usually a long waiting list for patients needing buprenorphine from the FQHC. As for methadone, the Drug Enforcement Administration has not approved an OTP being able to use a FQHC to dispense.
CODAC will measure whether the program improves retention. It will use a Skype-like tool for patients to communicate with CODAC on a computer. Working with Rosemarie Ann Martin, PhD, of the Brown University School of Public Health and Brown’s Center for Alcohol and Addiction Studies, CODAC will track the effectiveness of using telehealth to retain patients in treatment.
For Block-Islanders, Treatment Is a 45-Minute Ferry Ride Away
The program focuses especially on Block Island, a rural setting with no access to outpatient substance use treatment providers.
Ms. Hurley is formerly CODAC’s program director in Newport, the mainland port for Block Island. She tells AT Forum she is outraged that for Block Islanders to get treatment, they must take a ferry 45 minutes either way to the mainland. Under the new program, CODAC will send a dually licensed (mental health and addictions) counselor to the island.
The CDC, not CODAC, will pay for the cabling that will go under the water between Block Island and the mainland. Of course, this means that Block Islanders will have the benefit of cable that they don’t have now, all due to opioid treatment funds.
Rhode Island is one of the most advanced states in terms of expanding MAT. In other states, who would fund the required technology for telehealth? Most likely, the states, via grants from SAMHSA, said Mr. Parrino. New York’s Office of Addiction Services and Supports (OASAS) is already providing telehealth grants to its licensed OTPs.
Telehealth is inextricably tied to the satellite units, where medication would be dispensed, said Mr. Parrino. The brick-and mortar OTPs would establish the satellites, but at some point the patient would have to go to the hub site. Approval of satellite facilities (called “units”) is not as far ahead on the regulatory agenda as mobile vans, but they are another way to get much needed treatment to rural areas.