Tap into the Power of Telemedicine for Patients with SUD

Patients give many reasons for preferring home-based medication care for their substance use disorders (SUDs) — from lacking transportation to hospital clinics to desiring privacy while dealing with painful withdrawal symptoms.

So why does telemedicine remain out of the mainstream for SUD care?

That was the question tackled by presenters at a Sunday session of the 2024 Midyear Clinical Meeting & Exhibition, From No Wrong Door to the Front Door: Home-Based Medication Management for Substance Use Disorder.

Telehealth use skyrocketed during the COVID-19 pandemic when the federal government declared a public health emergency that reduced regulatory barriers and increased reimbursement rates. Under the emergency, controlled substances, including buprenorphine for opioid use disorder (OUD), could be prescribed via telehealth. Though the public health emergency ended, the telehealth flexibilities were extended, most recently through the end of 2025.

Barriers to increased use of telemedicine include providers’ and patients’ lack of comfort with the technology, state regulations, and low reimbursement rates, said Terri Jorgenson, a national program manager for clinical pharmacy practice integration and model advancement with the Department of Veterans Affairs (VA).

The VA is leading the way in offering telemedicine services, including for opioid use disorder treatment. More than half of the buprenorphine prescribed by the VA’s clinical pharmacy practitioners (CPPs) in 2023 was via telehealth, said Jorgenson. The VA has worked to help make sure veterans who want telehealth services can get them through a program that loans devices to patients who lack computers or reliable Internet access.

And those efforts are for a critical reason: “This is lifesaving care,” said Courtney Givens, a VISN 12 clinical pharmacy program manager for pharmacogenomics.

Though providers may worry about the safety of allowing patients to start their treatments in their homes, there is “weak to moderate evidence” suggesting differences in outcomes between home-based and office-based initiation of buprenorphine, said Troy Moore, a CPP supervisor with the VA Eastern Colorado Health Care System.

Moore described dosing strategies that tend to work well in home-based initiation of MOUD. On the first day, the patients would start 4 mg of buprenorphine followed by one to two additional 4 mg doses as needed every 1 to 4 hours. The patient has telehealth appointments on day one to three to discuss how to adjust the dosages to maintenance levels, with follow-up appointments after a week.

Yet Moore said practitioners need to consider carefully which patients are good candidates for home-based care. Considerations include hypersensitivity to buprenorphine, the severity of withdrawal symptoms, serious comorbid health conditions, and the stability of their home lives.

Jeffrey Bratberg, a pharmacy professor at the University of Rhode Island, described some of the federal resources for telehealth delivery of MOUD and gave an overview of private companies that provide telehealth services. He also provided resources showing how state telehealth laws and reimbursement policies limit expansion of SUD treatment.

But he argued that telehealth should be a key option for pharmacy to help patients dealing with a highly stigmatized disorder.

“This is a way to expand care, and to do it through pharmacists,” said Bratberg.