Telehealth Models to Address Substance Use Disorders

Telehealth is a promising tool for treating and supporting people with substance use disorders (SUD), helping overcome rural shortages of specialized behavioral health providers, resources, and access to medication treatment. Telehealth uses technology to provide access to services for treating SUD across a distance. It connects patients with providers and allows patients to receive screenings, counseling, prescribing, and other services without traveling to a provider's office. The Rural Telehealth Toolkit provides comprehensive information about models for increasing access to behavioral and mental health treatment, including care for people with opioid use disorder.

Some Screening, Brief Intervention, and Referral to Treatment (SBIRT) and behavioral therapy models have tested computerized or web-based versions with promising results. A computer-assisted or web-based version of behavioral therapy could benefit rural communities where transportation and access to care are barriers to treatment.

Smartphone apps are a telehealth tool that can support outpatient medication for substance use treatment. Smartphone apps can help providers and patients connect between in-person visits. They may offer medication reminders, progress tracking, surveys, scheduling, and other functions. For patients with smartphone access, apps can provide convenient tools and resources to support medication for substance use treatment.

For additional information about telehealth in rural areas, see the Rural Telehealth Toolkit.

Examples of Rural Telehealth Programs

Boulder Care has developed a completely virtual medication for opioid use disorder (MOUD) program. Patients communicate with program staff through video calls and messaging using the Boulder Care smartphone app. This evidence-based program has a 92% retention rate in the first 12 months of treatment.
The Medical University of South Carolina's Mom's IMPACTT (IMProving Access to Maternal Mental Health and Substance Use Disorder Through Telemedicine and Tele-Mentoring) program is dedicated to expanding mental health and SUD care for pregnant and postpartum women in South Carolina. This program recognizes the urgent need for improved maternal healthcare and provides evidence-based treatment for women experiencing perinatal SUDs or perinatal mood and anxiety disorders. Mom's IMPACTT uses a virtual care model to connect patients with a trained clinician for care coordination, assessment, and referrals to treatment. This approach has proven successful in increasing access to care and improving treatment engagement among perinatal individuals.

Considerations for Implementation

Telehealth treatment of SUD is quickly evolving. A major component needed for this model is access to high-speed internet, which remains a barrier in many rural communities. Telehealth requires access to equipment that may be costly to rural clinics with limited resources. Agencies that develop telehealth programs may also need to establish new policies, procedures, and trainings on the use of new equipment.

Another consideration regarding rural telehealth for SUD is comfort and preference regarding telehealth use among both providers and patients. Some providers prefer in-person visits to build a relationship with the patient, ensure successful initiation of care, and manage ongoing treatment. Similarly, some patients may prefer personal connection through in-person visits over telemedicine visits. Additionally, patients may lack privacy needed at home to feel comfortable discussing sensitive topics like substance use via telehealth. Patients may also lack access to devices, including smartphones. During intake, programs can screen patients to gauge access to and availability of technology such as internet and smartphones.

Another important consideration for rural SUD programs with telehealth services is to adhere to the Health Insurance Portability and Accountability Act (HIPAA) regulations and federal confidentiality rules. For example, healthcare providers need to consider using private networks on encrypted software for videoconferencing. While a large percentage of the population is using traditional short message service (SMS) text messaging, this format is not secure and, therefore, would not be compliant with HIPAA regulations.

Reimbursement for substance use related telehealth services varies by state. The Center for Connected Health Policy maintains a collection of telehealth-related laws and reimbursement policies by state.

Program Clearinghouse Examples

Resources to Learn More

Center for Technology and Behavioral Health
Website
Supports the development, evaluation, and implementation of technology-based intervention tools focused on behavioral health. Provides program reviews and current literature on digital health technology applications for substance use disorder interventions.
Organization(s): Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College

Your Recovery Is Important: Virtual Recovery Resources
Document
Lists virtual recovery programs for a variety of mental health and substance use disorders.
Organization(s): Substance Abuse and Mental Health Services Administration
Date: 7/2021