Tele-treatment for substance use disorders
Like mental illness, substance use disorders are common and impact a significant percentage of Americans. With drug overdose deaths on the rise and the COVID-19 public health emergency limiting treatment options, finding effective ways to provide care is more important than ever.
Telebehavioral health interventions can be part of an integrated approach to treating substance use disorders, when used in combination with other treatment methods. Interventions can include screening and diagnosis, online counseling, consults for prescriptions, and individual and group talk therapy. Treating substance use disorders via telehealth requires expertise and training in addiction care.
Here are some special considerations to keep in mind for telehealth substance use treatment:
- Use a SBIRT approach to early intervention. SBIRT stands for “screening, brief intervention, and referral to treatment,” and is a common way to understand patient needs and to triage patients with alcohol use disorder. It can also be used for other substance use disorders.
- Familiarize yourself with medication-assisted treatment models. Medication-assisted treatment is an evidence-based approach that combines behavioral counseling or talk therapy with the use of prescription drugs to curb opioid or alcohol cravings.
- Aim for integrated care. Understand what is effective in your community and what treatments your patients are getting outside of telehealth visits. Tailor and integrate your approach with your patients’ in-person treatment.
- Be conscious of language and educational barriers to accessing care. Offer materials accessible in different formats and multiple languages. Use both images and words in your materials to address different patient literacy levels.
- Prioritize patient monitoring. As with any vulnerable patient in your practice, conduct a suicide screen at every contact for those at elevated risk. Although there are challenges to providing online suicide prevention support during social distancing, several suicide prevention methods can be adapted for use during and after COVID-19.
- Review rules and regulations for prescribing controlled substances via telehealth. Make sure you follow the correct steps and are in compliance to prescribe suboxone or other drugs, which are commonly used to treat opioid dependence. Identify vendors and local sites for patient drug testing as needed.
- Hire support staff. Some patients with substance use disorder may not have access to a phone or other basic tools. Support staff such as case managers can be vital in providing more hands-on help such as calling in prescriptions and connecting patients to treatment centers and social services.
- Focus on long-term, continued treatment. Get permission to continue follow-up contact with your patients. Schedule the next session before ending each telehealth appointment, if possible.
Tele-treatment for substance use disorder benefits
- Wait times are reduced, which means faster access to care and prescriptions when time is of the essence
- Patients can attend residential or in-person treatment while continuing work with their regular therapist or provider
- Providers get more insight into the patient’s condition by observing the patient’s home or where they live
- Apps and text messaging can supplement treatment plans by providing immediate support to cope with low-grade cravings
More information on telehealth for substance use disorders:
- Coalition Webinar - Telehealth and Substance Abuse (video) — from the National Consortium of Telehealth Resource Centers
- Telehealth Models — from the Rural Health Information Hub
- Barriers & Challenges to FQHC Use of Telehealth for Substance Use Disorder (PDF) — from the National Telehealth Policy Resource Center
- How to Prescribe Controlled Substance to Patient During the COVID-19 Public Health Emergency (PDF) — from the Drug Enforcement Administration
- Medication Assisted Treatment (MAT) and TeleMAT Standards — from the Mid-Atlantic Telehealth Resource Center
SpotlightUniversity of Maryland, Baltimore Mobile-Care-Unit
The University of Maryland, Baltimore’s Department of Psychiatry developed an RV mobile-care-unit. It provides mental health and substance abuse services to underserved and remote communities in and around eastern Maryland. The unit serves 15 to 30 patients a day and focuses on medication-assisted-treatment delivered in person and via telemedicine. To reduce barriers to care, the unit accepts walk-in patients and travels to different locations each week to reach patients who may not have access to reliable transportation. Read more on the University of Maryland, Baltimore’s Mobile-Care-Unit .