Telebehavioral Health and Opioid Use Disorder

The Rural Medication for Opioid Use Disorder (MOUD) Toolkit provides additional rural resources and considerations in the Telehealth Model for Improving Access to MOUD. The Health Resources and Services Administration also provides a best practice guide for tele-treatment of substance use disorders.

Rural communities are using innovative telehealth approaches to provide care for people with opioid use disorder. Examples of these approaches include:

• The Mission Virtual Clinic provides telebehavioral services to rural hospitals and primary care clinics in North Carolina. Telehealth services include around-the-clock crisis assessments, consultations for inpatients, and substance use assessments. Licensed mental health providers also use telehealth to provide counseling for patients receiving MAT in rural clinics.
• The California Department of Health Care Services is implementing the California Opioid Response Project to help address the opioid epidemic in areas with limited access to MAT, including rural communities. Several programs funded through the MAT Expansion Project are using telehealth to increase access to treatment. For example, Bright Heart Health offers a telehealth platform that connects behavioral health providers in remote locations to emergency departments (ED) in rural California. These providers can consult with the ED physician and call in or fax a buprenorphine prescription. In the ED, patients can also access the Bright Heart telehealth platform on a tablet to consent to treatment and make follow-up counseling appointments.
• The University of Vermont piloted an innovative Med-O-Wheel telehealth intervention to improve medication adherence for patients traveling long distances and facing lengthy waitlists to access MAT. Patients received a limited supply of buprenorphine or methadone in a locked pill wheel. The secure pill dispenser allowed patients to access the medication once a day, during a predetermined time window. When the device unlocked, patients used an mHealth application on a smartphone or tablet to record themselves taking the medication via video. A second study of the Med-O-Wheel found that participants who received the buprenorphine were significantly less likely to report illicit opioid use than the control group. Other states, including California, are replicating Med-O-Wheel interventions to address long waitlists for MAT services.
• Mobile Health Units for Opioid Use Disorder Treatment describes a program of the Colorado Department of Human Services, Office of Behavioral Health that established six mobile health units to deliver telehealth services for opioid use in rural Colorado. Patients who visit the mobile units can hold a telehealth session with a provider to receive a prescription for MOUD. In 2020-2021, the mobile units served hundreds of rural residents of Colorado.

Implementation Considerations

The Center for Connected Health Policy monitors federal and state laws that affect online prescribing, including prescribing of controlled substances. Rural communities should keep informed of changes to federal and state regulations that affect the ability to prescribe controlled substances via telehealth.

Resources to Learn More

Medication Assisted Treatment (MAT) and TeleMAT Standards
Website
Provides a variety of resources for programs and providers seeking to implement MAT via telehealth.
Organization(s): Mid-Atlantic Telehealth Resource Center (MATRC)