Using Settlement Dollars to Expand Access to Treatment and Recovery Services
By: Henry Larweh
Telehealth, which usually involves using communication technologies, like phone or video calls, to connect healthcare providers with their patients, was widely used during the COVID-19 pandemic due to social distancing regulations. Funding telehealth strategies for patients with opioid use disorder can support the care and recovery of hard-to-reach and vulnerable patients, such as rural and native populations, or low income individuals who face decreased access to traditional resources. Because of its potential to reduce disparities in healthcare access for underserved populations, telehealth is considered an equitable solution (Principle 4).
Evidence-based telehealth services, such as video or phone consultations and webtrainings, can be used to support existing opioid remediation infrastructure. Other telehealth solutions, such as smartphone apps and text-services, have the potential to assist people in treatment and recovery, although further research is needed to ensure their effectiveness. The expansion of telehealth services during the COVID-19 pandemic was associated with significantly “reduced odds for fatal drug overdose”. Furthermore, patients expressed greater satisfaction for telehealth and improved access to buprenorphine.
Examples of Telehealth Strategies
Text-based services: Texting can be used to connect patients to their recovery supports.
- A study documented the message exchanges between individuals in recovery and their e-coaches, professionals who use telecommunication systems to offer services. These services can be tailored for people who wish to have recovery support services more quickly available or face barriers in reaching traditional supports.
Web-based training: Creating online access to traditional training for the opioid epidemic response may increase its reach and impact.
- Overdose education and naloxone distribution is a strategy already employed by some states to increase knowledge and use of naloxone to reverse opioid overdoses. A study looking into these online programs and their effectiveness in increasing outreach and availability of naloxone show that the online programs are well received and easy to administer for people to learn. Expanding online overdose education and naloxone distribution could help reach populations without immediate access to in-person programs.
Teleconsultation: Telehealth interventions do not need to be limited to patient-provider interactions, and can be used to coordinate multiple parts of a healthcare system to prevent opioid overdoses.
- An opioid pain teleconsultation service out of Colorado was evaluated for its effectiveness in reducing opioid use among patients who seek pain medication. The service provided automatic consultation by a physician pain specialist with the prescriber should a patient attempt to fill a prescription above a certain threshold. The intervention was found to significantly reduce opioid use among people who did trip off the system at pharmacies. The teleconsultation service may support already existing prescription drug monitoring programs in states.
- A retrospective cohort study explored how a telehealth intervention affected the retention of patients in treatment programs using medications to treat opioid use disorder. The researchers adapted the Tele-Harm Reduction model to provide patients access to their providers for follow-up during treatment. They found positive correlations between retention and utilizing telehealth services with a provider. An intervention such as this can expand the reach and impact of programs looking to start and keep patients using medication to treat opioid use disorder.
Smartphone Apps: Smartphone applications can be used to supplement treatment or recovery services that may improve the experiences and health of participating patients.
- Researchers in Arkansas developed a smartphone app to assist rural populations who may be far removed from opioid treatment centers and programs that use medication to treat opioid use disorder. (It should be noted that this intervention has not been evaluated for effectiveness.)
- A study conducted in the United States, Taiwan, and China explored how a smartphone app intervention could aid heroin-dependent patients who were in recovery. Involving the expertise of providers and people working in recovery, this app provided self-monitoring and management tools to participants. Participants expressed that the app-based service improved experiences with their recovery and ability to resist relapsing.
Considerations
Telehealth provision and access faces limitations in both practice and law. Surveys show that some medical providers worry about limited access to patient information and face-to-face interactions. State policymakers considering expanding telehealth services should be sure to educate themselves as states’ laws handling licensure and administering of telehealth care differ. Some states require face-to-face interactions between providers and patients for an ordered prescription to be valid.
Special considerations should also be given to rural and underserved populations. Many of these areas still do not have access to high speed internet or cellular service. Without the necessary infrastructure to support these services, they may not have the desired impact. In March 2024, SAMHSA published a new rule allowing for initiation of buprenorphine treatment through phone calls or video calls and methadone treatment through video calls without an in-person examination of applicable prescribers and providers.
Summary
Telehealth interventions can be effective strategies where states and jurisdictions can use settlement funds to improve existing infrastructure or introduce new programs. These types of programs can be especially beneficial for rural populations. In order to maximize the benefit and effectiveness, states should review their laws and regulations for telehealth to minimize possible restrictions to access of MOUD through telehealth.
States and local jurisdictions should also consider allocating a portion of their settlement funds to start and evaluate telehealth programs. They should analyze what areas of their opioid remediation infrastructure are in need of telehealth support, or where they can fund innovative strategies for previously hard to reach populations.
Henry Larweh is a Graduate Research Assistant with the Bloomberg Overdose Prevention Initiative and Master of Science in Public Health in Health Policy candidate at the Johns Hopkins Bloomberg School of Public Health. He is also an Intern with KFF Health News reporting on a range of topics related to the opioid settlements and SUD policy.