The United States has been experiencing an “opioid epidemic” of crippling magnitude that has led the Government on October 26, 2017 to declare the opioid crisis “a public health emergency.”
Millions of people have been diagnosed with opioid use disorder (OUD) over the past few years, with a surge in death rates due to drug overdose. In addition to the massive loss of life, OUD has caused a significant financial toll due to loss of productivity, disability, healthcare costs, as well as physical and mental co-morbidities. While the epidemic has affected people and families nationwide, rural regions have been particularly impacted. High prevalence of OUD in rural communities has been accompanied with limited availability of and access to treatment, making the opioid epidemic particularly devastating in rural regions.
Challenges to access
The epidemic has led to a significant increase in demand for OUD treatment, which typically requires long term services that incorporate both psychosocial services and pharmacotherapy. The pharmacotherapy component includes primarily methadone or buprenorphine for maintenance therapy, as well as naloxone for opioid overdose and naltrexone for relapse prevention. However, access to OUD treatment continues to face multiple challenges, including the shortage and unequal distribution of psychiatrists and other prescribers, particularly in rural communities. This leads to long wait times, treatment interruptions, poor patient satisfaction and suboptimal outcomes. While there has been some increase in the capacity to treat OUD, this has not been able to keep up with the soaring need and demand for treatment, causing ongoing limitations in access to care. Another challenge to accessing treatment for OUD is the stigma associated with addictions and with addiction treatment. While we have come a long way when it comes to decreasing the stigma of mental illness, the stigma associated with addiction persists, discouraging some patients from engaging in treatment.
Telepsychiatry is the use of videoconferencing to provide psychiatric services remotely, and it has gained strong support over the past few years as an effective and cost-efficient approach to providing care. Telepsychiatry has proven to be useful across multiple clinical settings, different patient populations and several treatment modalities. With regards to OUD treatment, videoconferencing is considered comparable to in-person treatment, with similar clinical outcomes.
Given the shortage and unequal distribution of psychiatrists, telepsychiatry is an essential tool in enhancing patient access to treatment, through direct patient care and consultation services, and within outpatient, inpatient or emergency room settings. While buprenorphine is not the only medication used in OUD treatment, the term “telesuboxone” has gained popularity to describe telepsychiatry when used in the treatment of OUD.
Within the context of rural communities, telepsychiatry decreases the burden of treatment on patients by decreasing the cost and time associated with having to travel outside their communities for treatment. Furthermore, videoconferencing provides patients with a certain level of anonymity, as it provides the options of receiving services in a more private setting, alleviating concerns about stigma.
While declaring the opioid epidemic a public health crisis reflects political will, strategies to combat the opioid epidemic must include enhancing access to care, via innovative approaches. Given the continued shortage and unequal distribution of psychiatrists and other prescribers, along with the stigma of OUD, and given the proven efficacy of videoconferencing, telepsychiatry is ideally positioned to play a significant role in combating the opioid crisis.