Each day, opioids claim the lives of more than 130 people across the U.S. As this national epidemic continues to intensify, access to treatment has remained out of reach for many of the patients who need it most. While medication-assisted treatment (MAT) with medications like Suboxone is a proven method for treating opioid use disorder, there simply aren’t enough qualified providers to meet the need and the demand, particularly in rural and other underserved areas.
As healthcare facilities work to meet skyrocketing demand for MAT, a growing number are turning to telepsychiatry as an effective, cost-efficient solution. With recent changes in the law making it easier to deliver MAT via telepsychiatry, this technology-enabled approach is expanding access and saving lives in communities ravaged by the opioid crisis.
A growing crisis
More than 300,000 Americans have died from opioid-related overdoses since 2000, prompting the federal government to declare a national emergency in 2017. Beyond the immeasurable toll on human life, opioid use disorder costs the U.S. an estimated $79 billion annually in related healthcare, lost job productivity, disability, and physical and mental comorbidities.
Rural communities have been the hardest hit, experiencing opioid misuse rates five times higher than the rest of the country. To help these patients break the cycle of addiction, a long-term approach that combines psychotherapy with medication is critical. These forms of MAT include Suboxone, Zubsolv, Bunavail and Cassipa, and feature a combination of buprenorphine and naloxone to combat opioid addiction. One drug approved by the U.S. Food and Drug Administration, Suboxone, has been proven to increase the success rate of treatment from 7 percent to about 50 percent. It’s no wonder, then, that demand for Suboxone and other forms of MAT has soared by 900 percent in recent years.
In many areas, the spike in demand for Suboxone treatment is straining an already limited supply of mental health clinicians even further. According to one study, three in four rural residents don’t have access to advanced behavioral health specialists. For specialties like substance abuse treatment, there simply aren’t enough psychiatrists to keep up with the need for services. Providers who can prescribe Suboxone are even more scarce, with just 5 percent of U.S. doctors holding the required federal waiver to prescribe medications that treat opioid dependency. This mismatch between demand and supply is putting thousands of lives at risk, requiring healthcare organizations to rethink how they deliver mental health services to patients in need.
Expanding opioid treatment through telepsychiatry
Last year, the Drug Enforcement Administration issued a statement clarifying how practitioners could use telemedicine as a tool to expand access to Suboxone-based MAT, providing a lifeline to communities with limited access to treatment. Research shows that telepsychiatry is just as effective as in-person MAT treatment as measured by additional opioid use, how long patients stayed off opioids and how likely they were to stick with treatment.
Along with improving access to care, using telepsychiatry for MAT can also improve cost efficiency for rural facilities. Clinics that don’t have the resources or patient load to support a full-time psychiatrist can right-size services for their needs. Moreover, having a psychiatrist assess and treat patients earlier can help reduce the need for more expensive acute care later. With stigma around mental health and substance use care still prevalent in many rural communities, telepsychiatry allows patients to videoconference with telepsychiatrists who can deliver substance abuse treatment while patients are at their primary care providers’ offices. That means patients can receive care without having to travel to a substance abuse clinic, making them more likely to follow through on treatment.
For facilities implementing telepsychiatry to deliver MAT, the following steps can help ensure regulatory compliance and quality patient care.
- Understand and follow all regulations. Any clinician who prescribes Suboxone needs to hold a federal waiver, have the appropriate HHS-required training and experience, and hold the correct medical and DEA licenses. In addition, facilities need to meet additional requirements to be eligible to provide Suboxone treatment. Since these laws are evolving rapidly, consider enlisting the help of an experienced partner who can ensure your program meets all necessary standards and remains in compliance.
- Select the right staff. Finding a telepsychiatrist who’s the right fit for your facility is critical for a successful program. Beyond meeting mandated requirements, your psychiatrist should have demonstrated experience and a genuine interest in addiction treatment, which can be clinically and emotionally challenging work. Since psychotherapy is an important part of overall treatment, make sure you have a therapist available virtually or as part of your in-house staff. A successful Suboxone treatment program should also include a nurse who can take vitals on-site, perform urine toxicology screens and monitor patients while they take their first dose of Suboxone.
- Set up e-prescribing. E-prescribing is an important tool to get life-saving medications like Suboxone into the hands of patients seamlessly. If e-prescribing isn’t available through your electronic health record, your external telepsychiatry partner should be able to provide access to a high-quality e-prescribing system.
- Adopt a holistic approach. Addiction stems from a complex set of factors, with conditions like depression and anxiety both leading to and resulting from substance abuse. By adopting a collaborative approach, virtual and on-site clinicians can work together more effectively to address co-occurring conditions, assess and treat opioid use disorder earlier, and improve patient outcomes while reducing healthcare costs. Telepsychiatrists should connect regularly with in-house clinicians to review patient history and develop treatment plans, so they can ultimately provide whole-person care.