Is Telemedicine the Answer to Rural Expansion of Medication Treatment for OUD?
Addiction Science Made Easy
Meg Brunner, MLIS
CTN Dissemination Librarian
Telemedicine (TM), the use of digital health technologies to provide medical services, has been considered a key solution to increasing access to health care in rural communities. However, despite the impact of the opioid epidemic on rural regions and the lack of resources in those areas to provide effective treatment to all those in need, the use of TM to treat opioid use disorder (OUD) has been limited.
With the immediate need for remote care due to COVID-19, many restrictions on TM were waived, and health care systems have rapidly changed their practices to include telephone, video chat, and other technologies for primary care and specialty services, including medication treatment for OUD (MOUD). Though this seems like a positive step and many have advocated for its continuation after the pandemic ends, actual research on the implementation and effectiveness of TM-based MOUD is limited.
To address that gap in the research, National Drug Abuse Treatment Clinical Trials Network protocol CTN-0102 (Rural Expansion of Medication Treatment for OUD) was developed. The study aims to investigate implementation and effectiveness of TM-based MOUD in rural primary care clinics.
To prepare for this 5-year, large-scale, randomized controlled trial, a feasibility study was conducted to develop and pilot test implementation procedures. In this commentary piece, members of the study research team share their experiences, including the challenges they encountered while they were working with rural primary care clinics during the initial two-month period of the feasibility study phase.
Those challenges included
- low rates of identification of risk for OUD from screening in primary care,
- low rates of referral to TM,
- digital device and internet access issues,
- workflow and capacity barriers, and
- insurance coverage for care.
Though these challenges may not be specific to rural communities, they appear to be worsened by vulnerabilities unique to rural areas (digital access and social distress and isolation, for example) and could have a substantial impact on the larger trial and on TM-based MOUD more broadly. They also highlight the lack of empirical guidance for best TM practice and quality remote care models.
Conclusions: TM offers options and solutions to many barriers to OUD care that rural communities face. As TM services continue to expand, and expand rapidly, understanding implementation and figuring out which TM approaches are effective will be critical for ensuring the best care for people with OUD.