COVID-19 has the potential to worsen the opioid epidemic and make it even more difficult to get addiction treatment. Social distancing requirements have put walk-in clinics, syringe exchange programs, and some other services on hold. In the face of heightened stress, joblessness and social isolation, people may be more likely to try to cope by turning to drugs and alcohol. People in addiction recovery are particularly vulnerable to relapse during times of stress.
The pandemic has also made it harder to get drugs into the U.S. Although this sounds like a win, supply chain disruptions can cause shortages that lead addicts to engage in risky behaviors and take any drug they can get their hands on. Taking unfamiliar drugs from unfamiliar sources can increase the risk of overdose. Already, several parts of the country are reporting spikes in overdose deaths. And with social distancing, there’s a greater risk that someone will overdose on opioids without anyone around to administer naloxone to save their life.
The Silver Lining: Removing Barriers to Treatment
At the same time, COVID-19 presents new risks for people with addictions, it threatens to undermine their access to treatment. Recognizing this double threat, federal agencies have temporarily changed regulations to make treatment more accessible, according to experts from the University of Michigan Addiction Center and VA Ann Arbor Healthcare System. Some of the changes include:
- Relaxation of Ryan Haight Online Pharmacy Consumer Protection Act. The Drug Enforcement Administration temporarily waived requirements for in-person visits for certain addiction treatments. For example, licensed providers can now prescribe buprenorphine (a research-backed medication for opioid addiction) virtually after an assessment through telemedicine, rather than requiring an in-person medical evaluation.
- New Guidance From the Substance Abuse and Mental Health Services Administration. SAMHSA updated guidance allowing some patients to receive up to 28 days of take-home methadone doses. This minimizes the need to travel daily to a licensed opioid program to get the medication.
- Changes in Medicare and Medicaid Reimbursement Rules. These changes make it possible for treatment providers to get paid for telehealth visits.
Can Telehealth Be an Effective Part of Addiction Treatment?
Early evidence suggests telehealth can play an important role in addiction treatment. Telehealth, or telemedicine, is the remote delivery of health care services using telephone, internet and other telecommunications technology.
Today, most health care providers use some form of telemedicine. Historically only about 1% of addiction treatment providers have used telemedicine, but COVID-19 has started to change that. Telehealth is an excellent option during COVID-19 and may offer benefits beyond this crisis as a supplemental part of treatment. Some of the benefits of telehealth for drug treatment include:
1. It makes treatment more accessible.
There is a shortage of easily accessible, affordable addiction services in many areas. Greater access to medications, therapy and peer support groups via telehealth could mean more people get the care they need. For some, it’s easier to admit a drug problem and ask for help if they can receive treatment via telehealth.
Telemedicine also can be a lifeline for people who don’t have transportation to drug rehab or appointments, who can’t afford traditional treatment, or who are unable to take time away from work or childcare responsibilities. It could also bring help to people in rural areas who otherwise can’t access treatment.
2. It’s well-received by patients.
Studies have shown patients are receptive to telehealth technologies such as video-based therapy and text reminders. While more studies are needed, research has shown that telehealth gets high patient satisfaction ratings. In addition, those needing medication maintenance treatment for opioid addiction have shown comparable patient retention and medication adherence for care delivered via telehealth as in-person care.
3. It could help prevent relapse.
Telemedicine may be able to keep patients engaged in treatment longer than traditional treatment. Since many people have their cell phones nearby most of the time, providers may be able to glean better insights into patients’ daily lives so they can intervene quickly and provide support. Check-ins via chat or text message could lead to more interactions with treatment providers over a longer period of time, which could reduce social isolation and lower relapse rates.
Providers can use telemedicine to identify and address mental health disorders as well. Addressing both substance abuse and co-occurring mental health conditions can help manage underlying issues that often lead to relapse. Telehealth also makes it easier to receive medications that promote recovery and reduce relapse.
New Changes Now Can Help in the Future
Most of us can’t wait until the COVID-19 situation stabilizes, but there are important lessons to learn from the pandemic. While in-person addiction treatment is still ideal, especially for people with acute needs, chronic relapse, and severe addictions, experts are hopeful that policymakers will preserve the regulatory changes made during COVID-19 and continue lowering barriers to getting help.