Telemedicine for the Treatment of Opioid Use Disorder
The prevalence of OUD has increased remarkably over the past decade resulting in significant morbidity and mortality and healthcare expenditures. In 2016, in the United States over 2.4 million Americans were diagnosed with OUD (Jones, 2017; Kolodny et al., 2015) and 64,000 people died due to opioid-related deaths (NIDA, 2017), resulting in a $78 billion annual economic burden (Macrae & Hyde, 2015; Florence et al., 2016). Medication assisted treatment (MAT) is the standard of care for OUD (Moore et al., 2016; Tai et al., 2013; Volkow et al., 2014), with evidence showing significant reductions in illicit drug use including opioid use, relapse, opioid-related overdose, criminality, infectious disease rates, despite national improvements in overall health (Mattick et al., 2009; Scwartz et al., 2013; Mattick et al., 2014; Mohlman et al., 2016). Despite indications that substance use treatment facilities have increased their adoption of MAT (Alderks, 2017), it has been estimated that only one-quarter (26%) of individuals with OUD access any form of alcohol or drug use treatment and less than one-fifth access OUD specific treatment in a given year (Wu, Zhu, & Swartz, 2016). In particular, the lack of medical care providers in many substance use treatment settings means. Nearly all states in the US have insufficient treatment capacity to provide MAT to all OUD patients (Jones et al., 2015). Lack of access to MAT is a main driver of low MAT utilization rates – particularly in rural areas of the country – more than half of which (60%) lack access to a physician waivered to prescribe buprenorphine (Andrilla et al., 2017). Telemedicine has become a common method for delivering medical services in urban and rural areas (Liddy, 2013), demonstrating significant clinical benefit as well as time and cost savings for patients (Dullet, 2017). Patients with OUD report that the delivery of MAT via telemedicine is an acceptable modality of treatment (Rakita, 2016), and patients receiving MAT via telemedicine have similar rates of abstinence and retention at treatment at 90 days and 1 year, compared to those receiving MAT in-person (Zheng, 2017). In one large study conducted in Canada, patients receiving MAT via telemedicine had higher treatment retention rates at one year, compared to those receiving in-person care [50% vs. 39%] (Eibl, 2017). The purpose of this presentation is to describe the use of telemedicine for the delivery of MAT to patients who are receiving substance abuse counseling in County Alcohol and Drug Abuse Authorities in the state of SC. The presentation will include the process of implementing this service including obstacles and challenges as well as successes. If available at the time of the summit, we will also provide preliminary outcomes from patients taking part in the TeleMAT service.