Researchers Question Value of Telehealth in Substance Abuse Treatment

Some prominent telehealth researchers are suggesting that providers pump the brakes on using connected health technology to aid in substance abuse treatment.

In a commentary published this week in the Journal of the American Medical Association (JAMA), Lori Uscher-Pines, PhD, of the RAND Corporation and Haiden Huskamp, PhD, and Ateev Mehrotra, MD, of Harvard Medical School say the value of telehealth and mHealth tools in Medication-Assisted Treatment (MAT) therapy hasn’t been proven, and that the drawbacks could outweigh any benefits.

“Research is needed on whether these services are comparable with in-person care on key metrics such as retention in treatment, effectiveness of long-term treatment for OUD, and cost-effectiveness,” the three wrote. “As with many telehealth innovations, growth may occur before the evidence base is strong because this new treatment model addresses a critical need and could potentially improve the care experience.”

The article targets an increasingly popular treatment for those dealing with substance abuse issues, such as opioid use disorder (OUD). To help in the withdrawal process, providers using MAT therapy prescribe a controlled medication, then carefully follow a patient’s progress with a treatment plan that includes mental health therapy.

In recent years, providers have looked toward telehealth to aid that process, by remotely prescribing the medications or using remote patient monitoring and telehealth platforms to stay connected with the patient during treatment.

With the COVID-19 pandemic, there’s also a heightened sense of urgency in connecting patients to their care providers, particularly since the emergency has forced providers to eliminate most in-person treatments. Healthcare providers across the country are reporting more cases of stress, as well as an increase in substance abuse issues.

MAT therapy is tightly controlled by state and federal regulations, in particular the Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which, among other things, allows providers to prescribe controlled substances after they’ve conducted an in-person examination.

Telehealth advocates have long argued that the Ryan Haight Act hinders care providers in treating patients with substance abuse issues, and have lobbied the US Drug Enforcement Agency to create a special registration process for providers. On March 16, citing the public health emergency caused by the coronavirus pandemic, the DEA temporarily waived that in-person requirement.

In their JAMA commentary, the three researchers cite the DEA action as well as increased Medicare coverage – including three new CPT codes – for OUD treatment to note that providers are rapidly adopting telehealth for these services. But they also question whether telehealth is appropriate and cost-effective and helps underserved populations.

They list five advantages and disadvantages to the use of telehealth. The advantages are:

1. It offers convenience, reducing the stress of travel and time off from work and family duties;
2. It increases access to care;
3. Through mHealth channels, it enables patients and providers to communicate more frequently, which aids in adherence and retention;
4. It offers additional privacy and confidentiality safeguards; and
5. It gives providers the opportunity to see patients at home, and to learn more about their home life and daily activities (and stresses).

 The disadvantages are:

1. It may not be appropriate for some patients, particularly those at high-risk or in unstable living conditions;
2. It requires patients to have access to a smartphone with a data plan and to have some technical literacy;
3. Accessing care from the home may create additional challenges for privacy and security, and may not be the right venue for some patients needing stability in treatment;
4. Some patients may be forced to pay out of pocket for the service, shelling out hundreds of dollars per month; and
5. While some studies are ongoing, none have as of yet provided data demonstrating that telehealth is making MAT therapy more effective.

“Given the scale of the opioid epidemic as well as new supportive regulations and sources of payment, telehealth treatment for OUD delivered at home will continue to increase,” the researchers conclude. “Also, the COVID-19 pandemic is likely to expand use of this model as many clinicians who treat patients with OUD are beginning to use telehealth for the first time. It remains unclear what will happen after the pandemic, both with regulation and sustained utilization of telehealth in the home.”

Uscher-Pines and Mehrotra are among the more notable and prolific telehealth researchers, and are known for questioning whether certain telehealth programs are proving their value. In 2019, they published a study that indicated physicians using direct-to-consumer telehealth platforms are more likely to prescribe antibiotics and ignore standards of care than those who treat patients in person.

They’ve also studied the value of eConsults and retail health clinics, and argued that telehealth programs need more pilot programs and research before they can be compared favorably to in-person care.