How Is Telemedicine Being Used In Opioid And Other Substance Use Disorder Treatment?

TLDR

Only a small proportion of people with substance use disorder receive treatment, especially in rural areas, and while telemedicine could expand access, regulatory and reimbursement barriers limit its use and monitoring of delivery models is needed. The study aims to describe how tele‑SUD is being used to inform policy efforts. Claims data from 2010–2017 for a large commercial insurer were analyzed to characterize tele‑SUD users and assess how tele‑SUD is combined with in‑person care. Although tele‑SUD usage rose rapidly, overall rates remained low—particularly relative to telemental health—and the modality was mainly used to complement in‑person care and disproportionately served patients with severe SUD, underscoring a missed opportunity amid the opioid epidemic.

Abstract

Only a small proportion of people with a substance use disorder (SUD) receive treatment. The shortage of SUD treatment providers, particularly in rural areas, is an important driver of this treatment gap. Telemedicine could be a means of expanding access to treatment. However, several key regulatory and reimbursement barriers to greater use of telemedicine for SUD (tele-SUD) exist, and both Congress and the states are considering or have recently passed legislation to address them. To inform these efforts, we describe how tele-SUD is being used. Using claims data for 2010–17 from a large commercial insurer, we identified characteristics of tele-SUD users and examined how tele-SUD is being used in conjunction with in-person SUD care. Despite a rapid increase in tele-SUD over the study period, we found low use rates overall, particularly relative to the growth in telemental health. Tele-SUD is primarily used to complement in-person care and is disproportionately used by those with relatively severe SUD. Given the severity of the opioid epidemic, low rates of tele-SUD use represent a missed opportunity. As tele-SUD becomes more available, it will be important to monitor closely which tele-SUD delivery models are being used and their impact on access and outcomes.