Opioid addiction and its impacts are widespread in the United States. Drug addiction has been the leading cause of accidental death and the numbers are increasing. In 2015, there were more than 50,000 lethal drug overdoses, with approximately 33,000 of those related to opioids. This represents a four-fold increase in overdose deaths involving opioids since 1999, with no signs of slowing down.
The path to addiction often begins with prescription pain killers. For example, consider the case of Mary, a 25-year old Caucasian mother of two in rural Appalachia. She was first prescribed opiates after the birth of her first child, and filled the prescription but took just a few. After the birth of her second child a year later, she was prescribed opiates again. This time, she experienced more pain and took more of the painkillers. She finished the painkillers from her previous birth as well. She sought additional pain relief at her post-partum appointment in a distant city and received another prescription. Prescriptions for opiates need to be filled out on paper and the distance was far, so the doctor made sure to give her enough to tide her over. At this point she was dependent on the prescription to manage caring for two children. Mary used her husband’s painkillers from an old back injury as well. Eventually, she overdosed and died, leaving two children.
Policymakers, providers and researchers have been grappling with how to support individuals like Mary and their families for some time. From our research, we see impact in addressing the crisis from effective deployment of telehealth: using technology to connect patients and providers who are not located in the same place.
Those most impacted by the opioid epidemic live in underserved areas (like Mary). These areas lack access to specialty and primary care providers who have experience in treating patients with substance abuse disorders. Effective deployment of telehealth addresses this gap to improve access to service delivery in these areas. Telehealth can assist in behavioral health treatment, specifically substance abuse disorders.
What is telehealth and how can it be used?
Telehealth is using technology to support, provide and promote healthcare from a distance. There are a variety of technologies which can support telehealth encounters. Activities include direct patient care, provider training and consultation, administrative meetings and provision of continuing medical education. The following are two main types of telehealth: Provider to patient and provider to provider.
1. Provider to patient
Telehealth used to provide care to a patient from a distance is called provider-to-patient interaction. It is essentially direct patient care. The most common is a live video interaction between the provider and the patient. Among the benefits of this type of interaction is the patient receiving care in his or her community in a timely fashion. Without provider-to-patient telehealth, patients would either travel to a community with access to necessary services, or wait for provider to come to their community if that service is available.
2. Provider to provider
Telehealth used for training, administration and continuing medical education is provider-to-provider interaction. Rather than providing direct services, this model uses telehealth to shore up local services to support substance abuse disorders, particularly for the opioid epidemic. Providers with experience and expertise in treating substance abuse disorders, such as medication assisted therapy (MAT) for opioid use disorders, use telehealth to train primary care providers with less experience. Telehealth is used for initial training and also for ongoing engagement and consultation. The end result is that patients can receive care in their own communities. Another benefit is that primary care providers who have an existing relationship with the patient can continue that relationship.
How can telehealth help with the opioid epidemic?
We have been studying the use of telehealth for behavioral health in frontier critical access hospitals, rural primary care settings, urban primary care settings and academic medical centers throughout the country. While the settings and uses of telehealth differ, the end goal is the same – to bring care to the patient where they are. Patients can benefit from not having to leave their communities and by having increased access. In addition, there is the potential for improved care coordination since the patient is receiving care in the same office where they receive the rest of their healthcare. Providers can also benefit from education, consultation and ongoing support. The distant providers can benefit from reduced no-show rates and improved coordination.
Telehealth has great promise as a tool to help fight the opioid epidemic as it provides patients such as Mary with access to care without having to leave her community. Providers can use telehealth to consult with specialists about conditions. It could also help in providing access to substance abuse treatment services. This access ultimately could have saved the life of Mary. We need to ensure others don’t suffer a similar fate.
Saira Haque specializes in the study of health information exchange, public and population health, and the intersection of technology and organizations.