Telehealth & the Democratization of Healthcare: Making Addiction Treatment Available to All People
By Deni Carise, PhD, Chief Scientific Officer, Recovery Centers of America
On April 21, 2022, President Joseph R. Biden submitted his administration’s National Drug Control Strategy to Congress. In his transmission letter, the president referenced his State of the Union address on March 1 when he called for the country to come together to beat the opioid epidemic by addressing untreated addiction and drug trafficking.
Biden said that all those challenged with substance use disorder (SUD) should know they aren’t alone. But the problem is that access to treatment remains an obstacle for many.
Not too long ago, if a person needed specialized treatment for a disease or illness, they were forced to travel to get it. Whether by car, train into the city, or flight across state lines, individuals traveled to get the best care — if they could take the time away from work or family and had the money to afford it.
Treatment could be time-intensive, inconvenient, and discriminatory, exclusive to those who could afford it. Additionally, the best practitioners could often only be found in select major cities and towns, leaving treatment for those in rural areas inaccessible. It could also be unaffordable to those without insurance, leaving those from lower socio-economic groups without choices
While the age of the internet made the possibility of telehealth a reality, and the Affordable Care Act made healthcare coverage available to most Americans, it is the unexpected COVID national emergency that led to multiple federal declarations resulting in massive expansions in coverage for telehealth.
Previously, only physicians could deliver telehealth services, and only to a patient who was at another physician’s office, hospital, or nursing home. The March 2020 declaration of COVID as a national emergency allowed for expansion of telehealth benefits under state waivers and various federal acts. Medicare and Medicaid, followed shortly by private insurance in most states, now cover telehealth services provided by doctors, nurse practitioners, clinical psychologists, and social workers to people at home, work, and other locations.
It’s an entirely new, widely available, delivery of care resulting in improved access to care, increasing equality, and affordability. Now, a person in a small, rural town can access high-level specialists from the comfort and privacy of their home. Significant barriers to care have been obliterated — and people are seizing the opportunity.
The unexpected COVID national emergency, thrust the world into a major experiment of telehealth’s potential. One positive outcome of the pandemic is that it helped accelerate telehealth services, expanding treatment options for even more Americans.
Telehealth has greatly contributed to the democratization of healthcare, creating a level of accessibility to all never before known. Treatment providers can deliver the same quality of service to every person regardless of location, health insurance coverage, or other barriers.
For those of us in the substance use disorder (SUD/addiction) treatment field, this might be our first chance to make treatment available to everybody. With telehealth, we can make an enormous impact on our nation’s staggering drug crisis that took the lives of more than 107,000 people from December 2020 to December 2021, setting an alarming new record in the overdose epidemic.
Imagine the person who can’t afford time — and money — intensive inpatient/residential care but can afford telehealth. They can still access highly qualified professionals who can provide quality care to more people — a true game-changer. Providers can hold meetings via secure platforms, share lists of resources and content, offer personalized services through apps to help support patients, and they can be reached instantly.
The benefits extend further. Research indicates that most people with SUD need at least three months in treatment to significantly reduce or stop their drug use and that the best outcomes occur with longer durations of treatment. We know recovery from drug or alcohol disorders is a long-term process and frequently requires multiple episodes of treatment. As with other chronic illnesses, relapse or recurrence can occur, signaling a need for reinstating or adjusting treatment. With telehealth, the “dose” of treatment can be ongoing, creating an affordable, extended period of care while still providing immediate intervention should the person be struggling with their disease. Keeping people in treatment longer, though tapering down in session frequency, will improve SUD treatment outcomes.
Some people — myself included — have argued that in-person treatment is preferable, a space where people can connect live, more accurately observe facial cues and gestures and see the need for more help, and feel the unmistakable bond that people in recovery have. But there are too many people struggling for whom in-person treatment is just not an option and where telehealth could really make a difference. The potential is huge when we consider that year over year in the U.S., only 10% of people struggling get any SUD treatment. If telehealth can make an impact on the other 90%, it’s certainly an option worth promoting.
Furthermore, it has been found that continuing care that lasts longer and uses more active efforts to engage patients in care produce more positive treatment effects and that adjusting treatment and using alternative delivery methods may lead to greater engagement and retention in care. This is particularly true for the large numbers of individuals who do not want traditional, in-person specialty care. This makes telehealth even more essential.
For these reasons, I call for all federal and state elected leaders to continue to make telehealth available nationwide to expand every Americans’ access to the care they deserve. Only then will affordable and immediate care truly be available to everyone.
“Telehealth & the Democratization of Healthcare: Making Addiction Treatment Available to All People”, denicarise.medium.com, https://denicarise.medium.com/telehealth-the-democratization-of-healthcare-making-addiction-treatment-available-to-all-people-a6b544239c04
