Telemedicine Medication-Assisted Treatment: A Key Part of Solving the Opioid Epidemic

If you’re reading this, you probably know someone – a family member, friend, or neighbor – who has overdosed from opioids. The President’s Commission on Combating Drug Addiction and the Opioid Crisis paints a grim picture in its Final Report, issued on November 2, 2017: in the U.S., more than 175 lives are lost to addiction every day.

There is hope, however, because of the tireless work of many families, advocates, health care providers, and officials at all levels of government. All stakeholders recognize that solving the opioid crisis will require many actions by governmental agencies, health plans, drug companies, providers, and private citizens. In fact, the Opioid Commission’s Final Report sets forth a daunting to-do list comprised of 56 specific recommendations — and the flow of dollars to implement these 56 steps is uncertain. But there is a clear path forward because we have a national consensus that medication-assisted treatment (MAT) for opioid use disorder can — and must — play an increasingly large role in combating addiction and saving lives.

The most common type of MAT drug, which includes a combination of buprenorphine (a moderately potent opioid) and naloxone (to deter diversion and misuse) has been approved by the FDA for more than a decade. MAT medications can be prescribed or dispensed in a physician’s office to treat opioid addiction (unlike older treatments such as methadone), so long as the prescriber has been issued a special DEA license, which requires completion of a brief training course. MAT treatment protocols typically include the management of medical issues, psychosocial therapy, and random urine testing. In 2016, the federal government increased the maximum number of patients that authorized MAT providers can treat at one time from 100 to 275, and now permits qualified nurse practitioners and physician assistants to prescribe MAT drugs.

The Opioid Commission’s Final Report recognizes that MAT resources are inadequate and misallocated across the country. As a result, many people suffering from opioid addiction have no access to an authorized MAT provider due to geographic or other barriers. That’s where telemedicine comes in, because it can remove time and distance barriers to get help quickly to the thousands – and perhaps millions – of people who need it.

Numerous studies published over the last decade have confirmed that MAT is an effective treatment for individuals with opioid addiction. Most recently, a study published in the Journal of Addiction Medicine in April 2017 concluded that MAT provided via telemedicine modalities is equally as effective as face-to-face MAT treatment for individuals diagnosed with opioid use disorder, as measured by additional substance use, average time to abstinence, and treatment retention rates. This is a landmark finding.

Although the patchwork of federal and state laws and regulations regarding telemedicine and teleprescribing has hindered the expansion of telemedicine MAT to date, this is likely to change very soon. The President’s October 26, 2017 proclamation declaring the opioid crisis a Public Health Emergency states: “The action allows for expanded access to telemedicine services, including services involving remote prescribing of medicine commonly used for substance abuse or mental health treatment.”

As the details of the President’s Public Health Emergency declaration are fleshed out, it will be important to see what directives emerge regarding telemedicine MAT. Amid this uncertainty, private accreditation for telemedicine providers can play a crucial role in ensuring quality treatment and patient safety. Since May 2017, ClearHealth Quality Institute has been working with the American Telemedicine Association to develop a best-in-class Telemedicine Accreditation Program, which will be launched during the next few weeks. For more information, click here.

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