Tech Access, Digital Literacy Barriers to Virtual Care for Opioid Use Disorder

Using telehealth for opioid use disorder treatment may increase access to care for individuals but it may be limited to patients with high digital literacy and those who are deemed stable by their clinicians, according to a study from University of Pennsylvania researchers.

The COVID-19 pandemic exacerbated the country’s opioid crisis and increased barriers to care as it spurred clinic closures, enhanced financial stress, and led to more instances of social isolation. Overdose rates increased in communities of color specifically, experts noted.

Telehealth adoption helped close care gaps during the pandemic by delivering virtual care to patients when in-person care was unavailable. Opioid use disorder treatment providers turned to the telehealth route as well, but some care disparities have remained.

Researchers from the University of Pennsylvania interviewed 22 opioid use disorder treatment prescribers from low-barrier, outpatient treatment programs in Philadelphia during July and August 2020.

The prescribers included physicians, physician assistants, nurses, peer workers, and social workers. They provided buprenorphine to patients without requiring counseling participation, behavioral treatment, or abstinence from opioids, thus characterizing the programs as low barrier.

The researchers asked the providers about their experiences using telehealth during the pandemic, how the transition affected them, the perceived impact on patients, their concerns about using telehealth, and their willingness to offer telehealth to patients in the future.

The responses highlighted three key factors. According to providers, telehealth led to easier access to care for some patients, but it also created a digital divide between those who are comfortable with and have access to technology and those with limited digital literacy. The providers also noted that while some patients may want to use telehealth, the final decision may depend upon clinician perception of stability.

Telehealth services for opioid use disorder treatment proved to be a convenient and flexible option for some patients, providers noted. Telehealth helped increase access to medication and treatment by removing barriers such as transportation, taking time off work, and finding childcare.

Receiving treatment via telehealth also helped eliminate triggers for some patients, as in-person care could require patients to see people or places associated with past drug use, providers said. Telehealth provided a timely option for care as well, which benefitted patients who needed immediate treatment as well as hesitant patients who could start treatment whenever they felt ready.

Despite the increased access to care, using telehealth for opioid use disorder treatment highlighted the digital divide among Philadelphia patients. Individuals in underserved or low-income communities did not always have reliable access to phones, internet, or other technology, the study respondents noted.

Additionally, a handful of patients who may have had proper access to technology did not have adequate digital literacy levels to navigate the telehealth programs.

Other patients simply did not understand that their virtual care services were equivalent to in-person care, one provider noted.

When questioned about the future of using telehealth for opioid use disorder treatment, the providers had mixed responses.

Some respondents said they would be open to offering both telehealth and in-person visits depending on what the patient needed or preferred. Making telehealth a permanent offering at treatment centers could benefit patients and prescribers alike who preferred virtual care over in-person services.

Other prescribers said they liked in-person care better because it provides face-to-face communication and the ability to observe body language. In addition, some services, such as urine drug screenings, are difficult to conduct via telehealth.

Most of the study participants responded that using telehealth for opioid use disorder treatment may ultimately be dependent on the provider’s perception of a patient’s stability and engagement with treatment.

For example, patients who adapted well to the telehealth transition during their recovery and actively participate in virtual treatment may be acceptable candidates for continued telehealth use. But patients who are new to the clinic or are just starting their recovery journey may benefit more from in-person care, providers said.

Overall, solidifying telehealth as a modality for opioid use disorder treatment could increase access for many individuals, but clinics and policymakers must address the digital divide and take action that increases access to internet and technology as well.