Opioid-related overdose deaths continue to climb, reaching 42,249 in 2016, reflecting the growing population with Opioid Use Disorders (OUDs) in need of treatment. Clinically, Medication Assisted Treatments (MATs) reduce the risk of OUD death by up to 50%. Yet access to MAT remains severely inadequate, notably in rural areas where, in 2016, 85% of counties lacked an opioid treatment program that could provide methadone and 60% lacked any buprenorphine-waivered provider.
There is a severe shortage of MAT prescribers, particularly in rural areas, and telemedicine offers the potential to fill this gap but is not yet prevalent. Therefore, understanding barriers and facilitators to adoption of this modality is critical.
This quantitative study surveyed MAT providers to understand their views regarding telemedicine for MAT to treat OUDs and involved a two-part design. First, surveys were administered to MAT prescribers of buprenorphine and naltrexone via email with an incentive to a sample of buprenorphine and naltrexone prescribers. Second, a geospatial analysis was conducted to analyze the mismatch between MAT availability and treatment need, identifying areas- particularly rural areas- where there is treatment capacity and/or support services compared to areas where treatment is actually provided.
Geospatial analysis revealed Substance Use Disorder treatment (SUDTx) facilities were more likely to be established in densely populated locations, and though most counties had at least one SUDTx facility, solitary facilities may not be accessible by the entire county’s population. Survey respondents were enthusiastic about engaging with telemedicine, with 61.7% (n=203) willing to provide telemedicine services. However, only 38.2% (n=177) reported currently doing so, citing a lack of authorization to treat across state borders, authorization to provide OUD treatment via telemedicine, and access to out-of-state patients’ state prescription drug monitoring program (PDMP) as prominent barriers to providing care. Logistical and legal barriers were cited as the largest barriers to care.
Respondents reported greater interest in providing MAT via telemedicine (n=202, 70.3%) than providing psychotherapy via telemedicine (n=174, 61.1%), and ranked pharmacotherapy via telemedicine as being more effective than any other proposed telemedicine services, including remote psychotherapy.