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3 existing opioid addiction treatment models can benefit from telemedicine.
As the death toll from opioid overdose increases — with more than 130 daily opioid deaths in the U.S. — combating this national crisis becomes ever more urgent. Government and public health officials have jumped in the fight, seeking to find effective ways to address our national opioid epidemic. Telemedicine is among a variety of solutions explored by the powers that be.
The U.S. Department of Health and Human Services (HHS) has pledged its commitment to improving access to life-saving treatment and is working on a number of strategies toward this goal. The organization is working with the Drug Enforcement Administration (DEA) to help clarify how clinicians can use telemedicine to expand access to medication-assisted treatment (MAT) for opioid use disorder treatment under the current DEA regulations. Also, the SUPPORT for Patients and Communities Act (H.R. 6) throws more weight than ever before at the notion of telemedicine as a viable tool in the fight against opioids. These recent changes in support, along with some outside-the-box thinking, present a clear opportunity for telemedicine, specifically telepsychiatry, to significantly impact the battle against opioid addiction.
Telemedicine presents new pathways of care. By its very nature, telemedicine can expand access to care while efficiently leveraging limited healthcare resource. Case in point: its ability to connect physicians with patients in rural communities — areas hit especially hard by the opioid crisis due to lack of appropriate care and/or certified providers. Today, telemedicine enables patients struggling with opioid use disorder (OUD) to instantly interact with mental health professionals from wherever assistance is required, rather than having to drive to a physician who may otherwise be hours away. This immediate point of care has proven crucial to patients with various behavioral and mental health issues and can produce similar results for those with OUDs.
Today, there are three leading pilot models for the treatment of opioid addiction, each which could benefit greatly from the use of telemedicine:
Hub-and-Spoke, a model out of Vermont, is a comprehensive treatment system for patients receiving MAT for opioid dependence. It is about networking: with regional opioid treatment centers (hubs) where staff are certified to administer addiction-treatment drugs for complex addictions, and nearby spoke facilities where a person may get maintenance treatment from local doctors, nurses and counselors. The hub and spokes work together to serve as many patients as possible and to tailor treatment to each individual. In this model, telemedicine can provide a physician for suboxone induction at the hubs and a consulting expert to local treatment teams.
Project ECHO (Project Extension for Community Health Outcomes) is a University of New Mexico care model in which providers meet regularly through a telemedicine platform to learn from specialists and share their challenges in treating patients. The model has proven successful in areas such as chronic pain and opioid management, substance abuse, cognitive rehabilitation and mental health. This model, in particular, allows telemedicine to play a major role as the vehicle for both telementoring and teleconsulting.
OBOT-B stands for Office-Based Opioid Treatment with Buprenorphine. Developed at Boston Medical Center in Massachusetts, it is a collaborative care model for the delivery of opioid agonist therapy with buprenorphine in which nurses, working with physicians, play a central role in the evaluation and monitoring of patients. This model plays to the very definition of telemedicine, and adding telemedicine could lead to great physician recruitment and exponential growth of outcomes.
The increased emphasis on controlling opioid addiction serves to spotlight that while telemedicine can be a promising tool in helping solve the opioid crisis, only through changes in legislation, outside-the-box implementation and adequate time for adoption will we be able to harness its full potential to help patients, save lives and solve the opioid crisis once and for all.
Avrim Fishkind, M.D., is general manager of psychiatry for SOC Telemed. He is a past president of the American Association for Emergency Psychiatry. He has designed multiple comprehensive psychiatric emergency programs including psychiatric emergency rooms, 23-hour observation units, mobile crisis outreach teams, crisis residential and stabilization units, crisis hotlines and short-term crisis counseling units. Dr. Fishkind has been employed in the delivery and development of comprehensive psychiatric emergency services in many locations, including New York City, Austin, Texas, Houston, Texas, Washington, D.C, and Toronto, Canada.
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