Telemedicine vs In-person Care: In Addiction Medicine, Options are Key

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In the shadows of the COVID pandemic, it was easy to ignore the growth of another public health crisis: the opioid epidemic. According to USA Today, drug overdose deaths hit a record high of 93 000 last year – a stunning 29% increase from the previous year.

For those struggling with opioid use disorder (OUD), the disruption of carefully curated treatment routines, coupled with the challenges of isolation and other pandemic-induced anxieties, created a tragically perfect storm.

Success was a pleasant surprise

Just as most businesses were forced to rethink their models overnight, OUD treatment providers, with the lives of these particularly at-risk individuals at stake, had to adjust operations in ways they never could have predicted. At Groups Recover Together, we transitioned our operations rapidly from entirely in-person to entirely virtual care and were pleasantly surprised by the resulting success: after 5 months, we saw no change in attendance rates at our weekly counseling sessions, no drop in the percentage of members remaining active in treatment after 3 months, and 87% of members felt as or more supported by clinicians in the virtual setting. We also didn’t see technology as being a major barrier to receiving care, with more than 80% of our members joining our weekly group therapy sessions via the video on their smartphone.

However, as the pandemic continues to evolve, so do the needs of our members and staff. Some patients have grown comfortable with telemedicine; others are feeling more strained than ever and want to incorporate in-person treatment back into their routines. Similarly, care providers have their preferences, as do family members and insurance companies. The path forward is uncharted territory, but it’s fair to say that all are willing to consider the benefits and drawbacks of virtual and in-person treatment and define the future of care delivery models as swiftly and thoroughly as possible.

Telehealth's permanent, positive impact

It’s no secret that the recent telemedicine boom has made a permanent, positive impact on healthcare. Thanks to new technology and virtual care options, patients have benefited from increased convenience and flexibility. Telemedicine has allowed for an unprecedented increase in access to quality OUD treatment due to simple logistics and regulatory changes, as well, connecting patients and providers across geographic barriers. For providers, telemedicine encourages efficiency, resulting in increased revenue. A particular bonus for addiction medicine, providers are able to see inside a patient’s home and potentially determine whether their environment is conducive to recovery. Telehealth makes it easier for family members and health advocates to join appointments and ask questions themselves, in real time, which is crucial.

High touch loses to high tech

Conversely, there are undeniable benefits to a traditional model of in-person care. Patients can better develop relationships with their care providers and peers when meeting face to face, which contributes to better outcomes. The rapport and emotional connection between patients and clinicians can be strengthened by direct eye contact or a hand on the shoulder. In behavioral health (and beyond), patients may feel more comfortable discussing personal issues in a clinical setting, when their home environments are often chaotic. In general, the ability to physically administer an exam is invaluable for providers. Absent are logistical obstacles such as internet connectivity or lack of technological equipment to compromise quality of care.

The future may be hybrid

Until we had the technology, in-person care was our norm; but now that it’ here, telemedicine isn’t going anywhere. The reality is that practices and larger health care organizations need to determine the way forward on a case-by-case basis. In addiction medicine, a hybrid model appears to offer the most benefits for all stakeholders. Patients have the flexibility to choose their preferred form of care delivery, and providers can expand the services they offer. New patients, particularly those at-risk populations in rural areas, can be reached without placing limitations on existing patients who desire in-person treatment. At the end of the day, a hybrid model provides options for custom care pathways, ultimately increasing the likelihood of positive outcomes.

At the national level, some positive steps were taken to encourage telemedicine and combat OUD during the pandemic, though most were focused on the short term. These regulatory changes reduced barriers to prescribing buprenorphine, which is the primary medication used to treat OUD, by allowing prescription distribution without requirements for an in-person exam. However, there is now the risk that Congress will let those regulatory stopgaps expire – policies that helped so many. For instance, we strongly urge Congress to permanently allow providers the authority to initiate buprenorphine for OUD treatment without the burden of an in-person visit. A permanent regulatory pathway for this type of treatment will save lives.

Patients have choice, options

Not long ago, if someone lived too far to drive to one of Groups’ brick-and-mortar clinics, we were unable to serve them. Now, we’re proud to say 30% of our members live in a county where we don’t have a physical location, each of them meeting with their recovery teams 100% virtually. Thanks to telehealth, we’re seeing members in communities that have been traditionally underserved, despite being disproportionately impacted by the opioid crisis. That is crucial, especially given that 40% of all US counties lack a single prescribing buprenorphine provider.

Telehealth has helped us be more flexible with our current members but perhaps more importantly, the widespread adoption of telehealth has undoubtedly helped those struggling under the weight of opioid addiction overcome barriers to accessing care in the first place. We know telemedicine is not for everyone, though; we’re planning to reopen our clinics in late September, but we will continue to offer telehealth as an option. We’re ready to meet individuals where they are and give them the flexibility they need to recover on their terms.

Groups Recover Together delivers opioid addiction recovery services that are proven to help individuals get their lives back on track. Groups provides fast, easy access to medication-assisted treatment (MAT), using Suboxone (buprenorphine), as well as a program designed to build a sense of community and accountability. In addition, members gain access to services through Groups' holistic care model, which is backed by the belief that long-term recovery from opioids is tied to social, behavioral and economic factors that aren't typically addressed in traditional treatment models.

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