CoVID-19, Substance Abuse, Substance Use, Telemedicine, Treatment



  1. Onderdonk, Mary DNP, CRNP
  2. Goldstein, Nancy DNP, ANP-BC, RNC, CNE


Abstract: Telemedicine has been effective at bridging the gap between patients, providers, and health systems. As part of a large, academic medical center in Baltimore, MD, it has been found that using digital tools, particularly when access to care is otherwise limited, is beneficial to supporting recovery. However, there are barriers to telemedicine surrounding patient privacy and increased tendency of patients to avoid treatment. Maintaining personalized, evidence-based clinical care while limiting the spread of CoVID-19 has required swift adaptation from healthcare providers. The intent of this article is to discuss provider perspectives of benefits and barriers to telemedicine for substance use disorder treatment during the CoVID-19 pandemic.


Article Content

In the United States, one in 12 (18.7 million) adults experience a substance use disorder (National Council for Behavioral Health, 2018). As of 2018, only 11% of those individuals received needed treatment (National Council for Behavioral Health, 2018). Unlike other healthcare specialties, substance use disorder treatment lacks a robust telemedicine component (Molfenter et al., 2018). During the CoVID-19 pandemic, substance use disorder treatment programs have had to quickly adapt to virtual visits and therapy sessions. Commonly used platforms to facilitate telemedicine visits include individual video calls, group video sessions, and telephone calls to provide therapeutic support.


During this global pandemic, telemedicine is being used in a variety of ways, making a positive contribution to substance use disorder treatment. Virtual platforms have allowed continued access to care as well as facilitated peer support groups and provider check-ins.


Support from peers and allies is a well-known tenet of the recovery process. One of the benefits of telemedicine is the flexibility it offers providers to act as allies. When in clinic, the patient may see his or her therapist and then have an appointment with the clinic provider. With telemedicine, it has been observed that the patients felt more supported by the calls he or she received on differing days from multiple clinic team members. Patients are also provided the opportunity to participate in virtual group sessions with their peers. This decreases the risk of CoVID-19 exposure for patients, being predominantly mindful of those with comorbid medical conditions. Maintaining peer support, even virtually, allows patients to successfully continue their recovery processes.


There may be some logistical difficulties in care access among those experiencing substance use disorders (Matsuzaki et al., 2018). Examples may include navigating public transportation, time off from work, or childcare. Our team has found the CoVID-19 pandemic has lessened the burden of some logistical difficulties, notably those patients who rely on public transportation or those who are primary caregivers of children or family members. Using telemedicine can decrease the time those patients who work are off the job. The patient is only responsible for answering a phone or video call rather than navigating stressful logistical barriers for an appointment.


A commonly cited barrier to virtual substance use disorder treatment is regulatory requirements for waivered providers, often necessitating an in-person visit (Uscher-Pines et al., 2020). However, during the peak of the CoVID-19 pandemic, in-person visits have been limited by CDC recommendations (CDC, 2020). Our team has been able to use telemedicine to successfully enroll patients in medication-assisted therapy, typically using buprenorphine. In addition, our team has been able to bridge methadone dosing to our clinic should the patient have a documented history and physical within 14 days (Substance Abuse and Mental Health Services Administration, 2020). The Clinical Institute Narcotic Assessment Scale for withdrawal symptoms has been reliably administered over the telemedicine video platform. These electronic platforms have allowed many of the day-to-day clinic activities to continue as usual, without the risk of exposure to CoVID-19.


Telemedicine, although undoubtedly useful, is not without drawbacks. We discovered the potential for patient privacy violations, especially when the patient answered a call in a public location. In addition, we have discovered a propensity for patients to use more avoidance and denial techniques via telemedicine.


Given the sensitive nature of substance use disorders, protection of a patient's privacy is of the utmost importance. Although consents are acknowledged before each visit, one barrier discovered during this pandemic is the potential for a Health Insurance Portability and Accountability Act violation. During an admission visit, one particular patient failed to disclose their significant other was online, listening through their discreet (difficult-to-visualize) Bluetooth earbuds. This likely would have been realized earlier had the visit been in person. It is additionally important for treatment team members to ensure the patient is in a private, distraction-free location, which may not always be achievable with a telemedicine visit.


Denial plays an important role in substance use disorders. Psychological processes such as distraction, forgetfulness, and repression may serve as variations of denial (Pickard, 2016). Our team found that, when patients were scheduled for telemedicine visits, they were more likely to use techniques such as forgetfulness or distraction to avoid discussing their treatment. It has been found some patients would not answer their scheduled telephone calls or would be distracted by talking to someone else during their visit. If the visits had been in person, this would likely not have been the scenario.


The CoVID-19 pandemic caused a rapid transition to telemedicine for treatment of substance use disorders. Although we discovered drawbacks such as potential privacy violations and increased tendencies for denial, benefits outweighed the drawbacks. Our team has found patients were generally receptive to receiving care via virtual platforms, as this reduced their concerns related to transportation, caregiver roles, and exposure to CoVID-19, while still promoting recovery. In the time of a global pandemic, telemedicine has been a promising option for supporting those with substance use disorders.




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