Telehealth Pilot to Combine Substance Abuse, Behavioral Health Care

A new project in Indiana aims to analyze the value of telehealth in treating people who are struggling with both substance abuse and mental health concerns.

The Indiana University School of Medicine and Regenstrief Institute are launching a four year, $4 million pilot to study the effectiveness of the MI-CARE (More Individualized Care: Assessment and Recovery through Engagement) program. Backed by the National Institute of Health’s National Institute of Mental Health, they’ll compare outcomes from 200 volunteers using the nurse-supported connected health platform against 200 patients receiving traditional treatment from primary care physicians. Kaiser Permanente’s Washington Health Research Institute will also take part in the program.

The project aims to determine whether primary care providers who use a telehealth platform can combine substance abuse treatment – including medication-assisted treatment (MAT) therapy – and behavioral health treatment to improve health outcomes. It targets the ongoing opioid abuse epidemic as well as an increase in depression and suicide rates brought on, in part, by the coronavirus pandemic.

"For decades, prescribing opioid medications to treat chronic pain was seen as a way to ease suffering,” Michael Bushey, MD, an assistant professor of psychiatry at the IU School of Medicine, affiliated scientist with the Regenstrief Institute and principal investigator for the study, said in a press release. “That well-intentioned practice has unfortunately contributed to an epidemic of opioid dependence and overdose deaths.”

"Providing services for opioid use disorder in primary care is the quickest way to reach the most patients, but we need to provide our primary care providers with the resources they need to be successful,” he added. “We hope that MI-CARE will allow many more patients in primary care to gain access to evidence-based treatments for opioid use disorder and depression."

Officials point out that substance abuse often occurs hand-in-hand with depression, and many primary care providers are ill-equipped to deal with both at the same time. A telehealth platform could give them access to resources for treating both – and help them develop a rapport with patients who are reluctant to seek help for mental health issues.

"A patient coming into the doctor's office with a heart problem typically doesn't have to be motivated to follow a treatment regimen, but for mental health issues, in part because of stigma associated with these disorders, patients often need support to become engaged and motivated to adhere to medications and other recommendations from their primary care physician," Kurt Kroenke, MD, a Regenstrief Institute research scientist, IU School of Medicine Chancellor's Professor of Medicine and co-principal investigator, said in the press release.

"In studies that we have conducted and in real world situations during the COVID-19 pandemic, telehealth has shown real potential in supporting patients and families,” he added. “The MI-CARE trial will evaluate telehealth's value, coupled with collaborative care, in the fight against opioid use."