By Eric Wicklund
May 29, 2020 – Some prominent telemedicine researchers are suggesting that vendors slow down the use of connected health technologies to support drug abuse treatment.
In a comment published this week in the Journal of the American Medical Association (JAMA), Dr. Lori Uscher-Pines from RAND Corporation and Dr. Haiden Huskamp and Dr. Ateev Mehrotra of Harvard Medical School The value of telemedicine and mHealth tools in MAT (Medication-Assisted Treatment) therapy has not been established, and the disadvantages could outweigh the benefits.
"Studies are needed to determine whether these services are comparable to personal care in relation to key metrics such as treatment retention, long-term treatment effectiveness for OUD, and cost effectiveness," wrote the three. "As with many telehealth innovations, growth can occur before the evidence base is strong as this new treatment model addresses a critical need and could potentially improve the care experience."
The article targets an increasingly popular treatment for people dealing with substance abuse problems such as opioid use disorder (OUD). To aid the withdrawal process, providers who use MAT therapy prescribe a controlled drug and then carefully monitor a patient's progress with a treatment plan that includes mental health therapy.
In recent years, providers have focused on telemedicine to support this process by remotely prescribing the medication or using remote monitoring and telemedicine platforms to stay in touch with the patient during treatment.
READ MORE: West Virginia Payer Expands Drug Abuse Treatment With mHealth Tools
With the COVID-19 pandemic, there is also a heightened sense of urgency about patients with their care providers connect to. especially since the emergency has forced providers to cancel most personal treatments. Healthcare providers across the country are reporting more cases of stress and an increase in drug problems.
MAT therapy is strictly controlled by state and federal regulations, particularly the Ryan Haight Online Pharmacy Consumer Protection Act of 2008 which enables vendors to prescribe controlled substances after they have been administered, including a personal test .
Tele-health advocates have long argued that the Ryan Haight Act hinders care providers in treating patients with substance abuse problems, and have campaigned with the US Drug Enforcement Agency to set up a special registration process for care providers. On March 16, the DEA temporarily waived this personal request, citing the coronavirus pandemic emergency in the area of public health.
In their JAMA comment, the three researchers cited the DEA action and increased Medicare coverage – including three new CPT codes – for OUD treatment to determine that providers are rapidly adopting telemedicine for these services. But they also pose the question of whether telehealth is appropriate, inexpensive and helps underserved populations.
They list five advantages and disadvantages for the use of telemedicine. The advantages are:
It offers comfort and reduces the stress of traveling and the free time of work and family.
It improves access to care;
Patients and providers can communicate more often via mHealth channels, which makes compliance and storage easier.
It offers additional safeguards for privacy and confidentiality. and
It offers providers the opportunity to see patients at home and learn more about their private lives and their daily activities (and stresses).
READ MORE: The Fauquier Clinic in Virginia switches to mHealth to expand access to care.
The disadvantages are:
It may not be suitable for some patients, especially those at high risk or in unstable living conditions.
Patients must have access to a smartphone with a data plan and have technical knowledge.
Accessing care from home can pose additional privacy and security challenges, and may not be the place for some patients who need treatment stability.
Some patients may have to pay for the service out of pocket and spend hundreds of dollars a month. and
While some studies are ongoing, no data has been provided to show that telemedicine makes MAT therapy more effective.
"Given the scale of the opioid epidemic, as well as new support regulations and payment sources, telehealth treatment for OUD delivered at home will continue to increase," the researchers conclude. “In addition, the COVID-19 pandemic is likely to expand the use of this model as many clinicians who treat patients with OUD are using telemedicine for the first time. It remains unclear what will happen after the pandemic, both in regulation and in the sustainable use of telehealth at home. "
Uscher-Pines and Mehrotra are among the more remarkable and productive telemedicine researchers and are known to question whether certain telemedicine programs prove their worth. In 2019, they published a study that stated that physicians who use telemedicine platforms directly to consumers are more likely to prescribe antibiotics and ignore standards of care than those who treat patients personally.
They also examined the value of eConsults and retail clinics, arguing that telehealth programs need more pilot programs and research before they can be compared to personal care.