The United States today confronts a massive public health crisis as more Americans fall victim to the opioid addiction epidemic.
Drug overdoses — the majority of them involving opioids — have claimed nearly half a million American lives over the last 15 years, according to a recent broadcast aired on PBS NewsHour.
Telemedicine, defined by the American Telemedicine Association as “the remote delivery of healthcare services and clinical information using telecommunications technology,” is emerging as a promising new weapon in the fight against addiction.
Telemedicine Technologies Advancing
Telemedicine has been around for decades in its more primitive forms, such as doctor-patient interaction via the telephone. However, today’s cutting-edge video conferencing and telemetry technologies have significantly improved the scope and the accuracy of the telemedicine platform.
The use of telemedicine to track the progress of recovering addicts and provide appropriate follow-up counseling was among the topics discussed at the annual meeting of the Addiction Industry Executive Summit in early 2017. While some substance abuse counselors already are using telemedicine to provide support for recovering addicts and find that its pros far outweigh its cons, others express skepticism about its effectiveness and worry about hefty start-up costs.
Telemedicine Supports Aftercare for Addicts
Among the more outspoken advocates of telemedicine is clinical psychologist Lisa Merconchini, whose Fort Lauderdale practice specializes in the treatment of substance abuse and mental health disorders. She told the conference that far too many recovering addicts drop out of aftercare when they leave treatment. Telemedicine, she said, “allows them to stay engaged and follow aftercare.” In the absence of a telemedicine link with their original treatment team, said Merconchini, addicts leaving rehab are often faced with the task of finding a new treatment team.
However, she said, telemedicine allows recovering addicts to continue working with counselors and physicians they already know. And because members of the original treatment team are more familiar with the recovering addicts, those medical professionals are far more likely to spot signs of a relapse. “You already have an established rapport,” said Merconchini. “Because you have had that in-person care, you are familiar with nonverbal cues.”
Not Everybody Embraces Telemedicine
Less enthusiastic about the potential of telemedicine in the treatment of recovering addicts is Corey Waller, M.D., senior medical director for education and policy at the Camden (New Jersey) Coalition for Healthcare Providers. He told the AIES conference that he had seen some telemedicine consultations conducted via a “laptop or itty-bitty webcam.” He said such interfaces don’t allow the doctor to see much of the patient except his or her face. Noting that medical professionals dealing with recovering addicts rely on the patient’s body language to assess progress or the lack thereof, Waller said, “If I can’t see the patient, I can’t see what’s going on. He could be flipping me off under the table.”
Waller estimated the cost of an audio and video system that can provide safe and effective treatment for recovering addicts at roughly $10,000, an expense that not all addiction counselors can afford. He also cited the confusion about telemedicine licensing requirements that vary from one state to another.
Telemedicine Progress Assessed
In an article published in a 2015 issue of “Addiction Science & Clinical Practice,” a research team recounted its findings from a February 2013-June 2014 study of the implementation of telemedicine into addiction services across five states and one county. The study’s lead author was Todd Molfenter, deputy director of the Center for Health Enhancement Systems Studies at the University of Wisconsin, Madison.
The research team observed that the use of telemedicine in addiction treatment and recovery is limited, at least in the five states and one county under study. This limited use of telemedicine is regrettable, they noted, because telemedicine “removes barriers of time and distance,” thus offering great potential for enhancing the treatment of people with substance use disorders, or SUDs.
Expanding Role Foreseen
Although telemedicine’s role was relatively limited in the areas they studied back in 2013 and 2014, researchers predicted a greater role for telemedicine as more advanced technologies become available.
“Yet, technologies that become part of standard practice will likely be a result of considerations of the technology’s costs, perceived benefits, and ease or difficulty of implementation.”
According to an article posted at mHealthIntelligence.com in July 2016, the federal government was about to launch a three-year, $9 million project to expand the use of telemedicine services in the fight against opioid addiction. The project will train rural health care providers to utilize medication-assisted treatment therapy in caring for an estimated 20,000 patients recovering from opioid addiction. Managing this new federal project is the Agency for Healthcare Research and Quality.
Project ECHO
At the heart of the new AHRQ program is Project ECHO (Expanding Capacity for Health Outcomes), a telemedicine training model that was first launched in New Mexico in 2011. The new AHRQ program targets Colorado, Oklahoma, and Pennsylvania, three states that have been particularly hard hit by the opioid addiction epidemic.
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