The opioid crisis is at its worst in rural areas. Can telemedicine help?
Some of the communities hit hardest by the opioid epidemic are in rural America. However, many of those same communities lack access to comprehensive treatment.
To address the epidemic’s increasing reach, the White House declared a public health emergency on Oct. 26. The administration outlined a need to expand treatment in rural communities, most notably by making telemedicine more readily available.
Drug overdose deaths are rising in rural areas across the U.S. In 2015, the overdose death rate for rural areas surpassed the death rate for urban or suburban areas. People living in rural areas were four times more likely to die from overdoses in 2015 than they were in 1999. The opioid epidemic hit states east of the Mississippi River hardest, with the highest death rates in relatively rural states: West Virginia, New Hampshire, and Kentucky.
The most scientifically supported opioid treatments combine medications—like buprenorphine, methadone, or Suboxone—with behavioral therapy. These opioid treatment programs help patients stop abusing opioids and promote long-term recovery.
However, people living in rural areas face a number of barriers in accessing opioid treatment. Many rural populations have a limited number of clinics that provide opioid treatment and behavioral therapy, as well as a shortage of providers who prescribe opioid treatment medications. People living in rural areas frequently travel long distances to their opioid treatment provider. Moreover, many may feel ashamed or stigmatized if they seek out opioid treatment in their local community.
With these issues in mind, telemedicine seems like a promising way to help rural communities, and specifically, to aid in rural opioid treatment.
One study from Ontario demonstrated that the more sessions patients attended via telemedicine, the more likely they were to stay in an opioid treatment program. Patients in the study attended telemedicine sessions under a nurse’s supervision at an affiliated opioid treatment clinic. The prescribing physicians, who likely oversee other clinics from afar, were videoconferenced in from a different location. Videoconferencing helped patients better access providers to discuss medication issues, but still required patients to travel to an affiliated clinic.
The White House has yet to provide explicit details on how expanded telemedicine services will be funded. The US$57,000 released through the public health emergency isn’t enough by itself to lead to meaningful changes and needs renewal after 90 days.
The use of telemedicine for opioid treatment also presents particular challenges. Providers are required by law to see patients for initial in-person assessment before prescribing controlled medications like Suboxone.
There are exceptions to this law, including letting the patient see other clinical staff in person while videoconferencing with the prescribing physician. The emergency declaration could offer even more flexibility.
What’s more, most people need services for other problems besides opioid addiction, such as mental health problems like depression or difficulties with other drugs like cocaine. Many also lack private health insurance or financial means to pay out of pocket for telemedicine.
Despite these issues, the administration’s call to improve treatment access is a positive step for rural health.
