The promise of telehealth for improving large swathes of healthcare is significant, but most use cases to date have been in areas such as mental health.  In a recently published paper, researchers from Harvard Medical School argue that it’s a technology that is currently massively underused in treating substance abuse.

“The low rates of telehealth visits for substance use disorder that we found represent a missed opportunity to get people the help they need, especially in the context of the ongoing opioid epidemic,” the researchers explain.

The data was generated from an examination of insurance claims made between 2010 and 2017 to try and determine how telehealth was being used in the United States.  During this time, uses of the technology for substance abuse grew from 0.62 visits per 1,000 diagnosed in 2010 to 3.05 visits per 1,000 diagnosed in 2017.  Despite this significant growth however, usage remains very low, and represents just 1.4% of all telehealth consultations.

Tackling substance abuse

The problem is a considerable one, with around 21 million Americans having some kind of problem.  This has resulted in deaths from opioid abuse quadrupling from 1999 to 2016.  Whilst there are a range of treatments currently available, it’s estimated that just 20% of people actually receive any.

The researchers believe that telemedicine can increase access to treatment, especially for those in remote or underserved communities.  What’s more, it can also help reduce the stigma attached to treatment by allowing people to receive it from their own home.

The data however reveals a sketchy picture, with significant geographic variance.  Substance issues are highest per capita in rural areas, but most telecare is provided in urban areas.  The data suggests more should be done to target such interventions at people in rural communities.

What’s more, telehealth was almost always offered as an add-on to in-person care rather than as a standalone intervention.  The authors believe the reverse could actually be a better route, with telehealth providing an easier way into treatment that can then be scaled up if required.

Barriers to overcome

For this potential to be realized however, a number of barriers need to be overcome, not least of which is the relative shortage of substance abuse support.  There are also regulatory challenges, whilst obstacles around prescribing controlled substances often mandate a physical visit.

It’s an area of growing interest however, and the researchers hope that their work provides a baseline from which to explore some of these challenges and help bring the technology to a wider audience.

“Many experts believe that mental health conditions and substance use disorders may be particularly well-suited to telemedicine because their treatment doesn’t require an in-person exam,” they explain. “I think more and more providers are getting interested in delivering telemedicine for these conditions in part because they view it as a way to expand access and possibly improve engagement in treatment for these conditions where access is a real problem. “