Defining and supporting high-quality telehealth for patients with opioid use disorder: The promise and potential pitfalls of telehealth expansion

Abstract

Many patients with opioid use disorders do not receive evidence-based treatment. The COVID-19 pandemic expanded the use of telehealth for prescribing medications for opioid use disorder (OUD). The uptake of telehealth has been variable, and this uneven expansion has created natural experiments to test assumptions and answer key questions about what improves outcomes for patients with OUD. Many current quality of care measures are not patient centered and do not focus on the practical questions that clinicians face. What criteria should be met before prescribing buprenorphine? Are physical exams necessary? Does the frequency and type of drug testing predict clinical outcomes? Are short check-in visits by phone or video better than less frequent in-person visits? Answering these questions can help define the essential components of high-quality care for patients with OUD. Defining the features of high-quality care can help create guardrails that will help protect our patients from potentially exploitive and ineffective care. Telehealth will likely end up being one additional tool to deliver care, but the scientific questions that can be answered during this period of rapid change can help answer some of the fundamental questions about providing high-quality care—and that will help all our patients, no matter how care is delivered.

Keywords:

• Telemedicine
• telehealth
• harm reduction
• opioid use disorder
• buprenorphine
• opioid-related disorders
• quality of health care
• substance-related disorders

Disclosure statement

LAL consults on telehealth for substance use disorder treatment for the National Committee for Quality Assurance with funding from Alkermes. CJF and LAL have performed consulting work for the Providers Clinical Support System with funding from SAMHSA.

Additional information

Funding

LAL is supported by a US Department of Veterans Affairs Health Services Research & Development Career Development Award [CDA 18-008] and funding from the VA Office of Connected Care [OCC 21-11 and CDC R49 CE003085]. The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.