Integrating Telemedicine for Medication Treatment for Opioid Use Disorder in Rural Primary Care: Beyond the COVID Pandemic

• Published in: The Journal of Rural Health Vol. 37; no. 1; pp. 246 - 248
• Main Authors: Hser, Yih‐Ing, Mooney, Larissa J.
• Format: Journal Article Web Resource
• Language: English
• Published: England John Wiley & Sons, Inc 2021; Wiley Subscription Services, Inc; John Wiley and Sons Inc
• Subjects: Addictions; Bridges; Buprenorphine; Chart reviews; Clinics; Commentaries; Community mental health services; Coronaviruses; COVID-19; COVID-19 - epidemiology; Crises; Drug abuse; Drug addiction; Drugs; Economies of scale; Epidemics; Government programs; Health care; Health care access; Health care facilities; Health care industry; Health services; Human services; Humans; Infrastructure; Licensing (technology); Management; Medicaid; Medical personnel; Medical treatment; Medicare; Medication Therapy Management - organization & administration; medication treatment for opioid use disorder; Mental health; Mental health services; Methadone; Military hospitals; Mortality rates; Naltrexone; Narcotics; Opioid-Related Disorders - drug therapy; Opioid-Related Disorders - epidemiology; Opioids; Overdose; Pandemics; Patients; Primary care; Primary Health Care - organization & administration; Public health; Quality of care; rural; Rural areas; Rural communities; Rural health care; Rural Health Services - organization & administration; SARS-CoV-2; State regulations; Substance abuse; Substance abuse treatment; Technology; Telemedicine; Telemedicine - organization & administration; Treatment programs; United States - epidemiology; Veterans; Videoconferencing - organization & administration; United States; United States > US; COVID-19; telemedicine; primary care; medication treatment for opioid use disorder; rural
• ISSN: 0890-765X; 1748-0361
• DOI: 10.1111/jrh.12489

Even before the 2019 Novel Coronavirus (COVID for short) crisis, telemedicine (TM) enabled by digital health technologies was considered a key solution to the health care access problem in rural communities. However, use of TM to treat opioid use disorder (OUD) has been limited even during the recent opioid crisis in America, despite the high rates of opioid overdose and death rates in many rural areas. This limited use of TM‐based medication treatment for OUD (MOUD) has been mostly attributed to restrictions imposed by federal and state regulations for TM (eg, licensing, reimbursement) and patient challenges (eg, accessing and using the technology). The current “collision of the COVID and addiction epidemics”1 forces a drastically increased demand for remote care models for MOUD. We reflect on what virtual high‐quality care entails and how access to these services can be expanded. The opioid crisis has hit hard in many rural communities and has brought health care access issues to the forefront in these areas.2 Opioid treatment programs that dispense methadone require frequent or daily visits which are difficult to adhere to given the long‐distance travel often required in these areas. Primary care is at the core of rural health care systems. To expand MOUD access, national efforts have focused on primary care to promote office‐based opioid treatment (OBOT), which allows clinicians to provide medication such as buprenorphine or naltrexone to treat OUD in their own clinical settings. Nevertheless, OBOT uptake has been slow in rural communities, with 29.8% of rural Americans compared with 2.2% of urban Americans living in a county without a buprenorphine provider. Studies using retrospective chart reviews have shown that MOUD delivered by TM is as effective as in‐person delivery. In response to the COVID pandemic, Centers for Medicare & Medicaid Services and Drug Enforcement Administration have taken unprecedented steps to relax rules governing TM for MOUD with waivers for policies and restrictions on TM during this public health crisis (declared by the Secretary of Health and Human Services on January 31, 2020), and the Substance Abuse and Mental Health Services Administration has published clinical guidance in support of these measures. Many clinics are rapidly adopting use of basic telehealth services (eg, telephone, video chat) to treat individuals with OUD. The development of MOUD capacity in primary care settings with comprehensive treatment services, while desirable, can be very challenging as health care providers in rural communities face limited economies of scale, heavy dependence on public payers, and low patient volume. To quickly expand treatment access in order to address the current urgent problems in rural communities, one strategy would be to bridge a collaborative relationship between primary care and an established TM provider that has developed relevant infrastructure to deliver comprehensive MOUD remotely. An example of such a remote model implemented in the Veterans Health Administration has been reported, using a hub (centralized prescribers teleprescribing buprenorphine) and spoke (rural clinics) model.8 There are also TM companies that have established infrastructure (delivering virtual MOUD by X‐waivered prescribers and licensed clinicians for behavioral health with services available 24/7, and accepting diverse payment or reimbursement mechanisms) and can provide TM services in many states across the country. By collaborating and coordinating with an established TM provider or network, rural health centers can extend their reach quickly, which can lead to improved quality of patient care and healthier communities.