Lin L, Fernandez A, Bonar E. (2020). Telehealth for substance-using populations in the age of coronavirus disease 2019: Recommendations to enhance adoption. JAMA Psychiatry. 77(12): 1209-1210. doi: 10.1001/jamapsychiatry.2020.1698
Lifting of telehealth restrictions during the COVID-19 pandemic (e.g., the U.S. Drug Enforcement Administration (DEA) has given emergency permission for prescription of buprenorphine and naloxone via telehealth) has facilitated rapid adoption of telehealth in substance use disorder (SUD) treatment. Yet many of these changes pertain only to care during the pandemic. For lasting, wide-scale adoption of telehealth SUD services (a scalable solution with the potential to increase treatment access), these changes must become permanent. The authors offer three recommendations to support sustainable implementation of telehealth for SUD. First, SUD telehealth would benefit from guidelines defining reasonable practices for telemedicine-delivered treatment, ensuring similar standards of care for all patients. Challenges include establishing frequency of treatment, obtaining urine toxicology screens, and modeling care for complex, high-risk patients. Mobile health (mHealth) technologies could be used to address these challenges (e.g., monitoring substance use remotely via self-report apps, transdermal devices, photo verification of mailed biological tests). Second, clinician education could facilitate telemedicine prescription of controlled medications such as buprenorphine to increase patient-reach in rural and other low-treatment-access areas. An educational toolkit intervention could inform clinicians about telehealth medical considerations, technology and infrastructure, billing, and reimbursement policies, changing federal-and-state-level regulations, and strategies to promote clinic adoption. Third, clinicians need additional tools and resources to help patients with SUDs and comorbid mental health disorders. Adapting psychotherapy treatments to telehealth (e.g., telehealth group therapy) and making mental health resources online-accessible (e.g., crisis and community support, case management) would support continued use of telehealth SUD services. Future research could compare the effectiveness of different modes of telehealth delivery (e.g., at-home, remote clinic, phone).