MedCity Influencers

Going virtual can save lives: The case for making telehealth a permanent part of addiction treatment

We must continue to push for the expansion of telehealth for Medication Assisted Treatment (MAT) more broadly and call on our federal leaders to do what is right…to change the game for good and make telehealth a permanent solution. Lives depend on it.

The pandemic upended many aspects of life, but it also pushed us to adapt and adopt new ideas. In healthcare, the expanded use of telehealth was a major game changer.

State and federal legislators eased telehealth restrictions relatively early during the pandemic to facilitate critical health interactions without exposing more people to the virus. In New Hampshire, Governor Sununu enacted Emergency Order 8, allowing individuals with opioid use disorder (OUD) to start Medication-Assisted Treatment (MAT) via telehealth. It removed the in-person requirement for MAT, which was a key barrier for many seeking care, and significantly increased access to life-saving treatment. For example, my company saw more members than ever — up to 96 percent — attend their initial medical evaluation, most starting medication for opioid use disorder within hours of reaching out.

Last June, however, the order expired, reintroducing the in-person requirement and excluding telehealth as an option for people with an OUD to establish care. As a result, wait times for appointments rose, engagement in care dropped, and the number of overdoses rebounded to pre-Covid-19 levels.

The impact of telehealth: how virtual services expand access across communities  

The impact of telehealth is simple: it allows more people to access care right when they are seeking it. And, this is particularly vital for addiction treatment, especially MAT.

Often, when individuals are seeking treatment for substance use disorder (SUD), the window of opportunity is very brief. In fact, it’s so brief that we lose 25 out of every 100 people who reach out to us for help when their care is delayed by requiring them to attend an in-person visit versus initiating treatment that same day via telehealth. Many of those looking for care lack the resources it takes to attend an in-person visit, like childcare, transportation, work schedule flexibility… and they are not able to wait for care. Virtual services remove those barriers and let people start on MAT with life-saving medications like buprenorphine, immediately. This reduces overdose risk and death while playing a critical role in health equity.

A success story in New Hampshire 

The move to make telehealth a permanent part of MAT services was and is urgent. In fact, it can be a matter of life or death for some.

Fortunately, New Hampshire passed an amendment last month, HB 503, to permanently expand telehealth access for MAT in the state. Policy changes, such as this, require strong synergies between providers, community members and legislators, quantitative and anecdotal data, and listening to the voices of those who are most impacted but oftentimes least represented.

Senator Tom Sherman, a physician and long-time telehealth advocate, played an important role in driving this change forward, collaborating with SUD providers to bring this critical issue to light and create a compelling case for telehealth expansion:

“We’ve seen the powerful impacts telehealth has had on several other aspects of health care, and it was time to extend that to addiction treatment. Beyond what the pandemic showed us, we stand behind the mountains of data that prove MAT is one of the safest and most effective approaches to substance use disorder, and believe that the more people who can access it because of telehealth, the better.”

State Senator Jeb Bradley was another key supporter:

“We must continue to support those in our communities struggling with substance use and mental health challenges and that includes providing them with the resources and support that they need. This amendment is an important step in easing access to appropriate and important treatments.”

Despite great work being done at the state level, time is still of the essence. The end of the federal emergency order, which trumps state regulations and could come as soon as October, will reinstate the in-person requirement for MAT, rolling back telehealth advancements nationwide, unless federal regulations are amended.

Changing the game for good

We, working together, have the power to ensure life-saving treatment can reach everyone who needs it. Telehealth is one of the most basic, fundamental ways. We must continue to push for the expansion of telehealth for MAT more broadly and call on our federal leaders to do what is right…to change the game for good and make telehealth a permanent solution. Lives depend on it.

Photo: sorbetto, Getty Images

David de Gijsel, MD, MSc, MPH is the Chief Health Officer at Better Life Partners, a community-based health care organization providing whole-person care to people who struggle with addiction. He holds appointments as Assistant Professor at the Geisel School of Medicine at Dartmouth and at The Dartmouth Institute for Health Policy & Clinical Practice. He is a staff physician in the Section of Infectious Disease & International Health at Dartmouth Health.

David focuses on the syndemic of poverty, trauma, addiction, and infectious diseases. He works towards social justice through community-based health care delivery, employing principles of harm-reduction, trauma-informed care, and liberation medicine.

David hails from the Netherlands, completing medical school at the University of Amsterdam and his residency in Internal Medicine & Primary Care at Montefiore Medical Center/Albert Einstein College of Medicine in the Bronx, NY. He completed a fellowship in Infectious Disease at Dartmouth-Hitchcock and a residency in Leadership Preventive Medicine, combined with an MPH at The Dartmouth Institute.

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