Can Telemedicine Address the Opioid Crisis in Rural America?

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Medications for opioid use disorder save lives. But for the more than 60 million Americans living in a rural community, these safe and effective treatments may be out of reach. Research from the Helping to End Addiction Long-term^® Initiative, or NIH HEAL Initiative^®, is looking for ways to address barriers.

Yih-Ing Hser, Ph.D., is exploring telemedicine as a strategy. Her team at the University of California, Los Angeles is testing a care coordination model at six rural primary care clinics that connects rural primary care clinics with external telemedicine providers. The findings are in, and they are promising: Patient use of medications for opioid use disorder increased at five of six rural primary care sites in three states (Maine, Washington, and Idaho). Perhaps unsurprisingly, effects were greater in rural primary care clinics that lacked capacity to treat patients with opioid use disorder and for those clinics with a high influx of new patients.

The research revealed existing hurdles to broader use of telemedicine.

1. Challenges to diagnosis

As a part of Hser’s study, clinics were asked to screen patients for opioid use disorder, which yielded fewer participants than expected. Some patients declined the screening or were dissatisfied with being asked what they perceived to be sensitive questions. Similarly, providers were uncomfortable discussing opioid use disorder with patients, expecting a negative reaction.

2. Low telemedicine referral rates

Some primary care clinicians involved in the study did not trust the effectiveness of telemedicine for opioid use disorder treatment. Only about 12% of eligible patients were referred to an external telemedicine provider. However, these rates appear to be on the rise since pandemic-inspired increased use of telemedicine.

3. Technology barriers

Many patients from all backgrounds who live in rural communities lack access to fast and reliable internet. In addition, some have skills gaps required to navigate online platforms. Thus, addressing technology needs is likely to be needed in parallel to help telemedicine find acceptance and broader use.

4. Insurance coverage issues

Although telemedicine-based opioid use disorder treatment is usually covered by insurance, hurdles remained. Participation in the study required that clinics accept Medicaid, the government program that provides health insurance for adults and children with limited income and resources. Not all the services were covered, however, by local Medicaid carriers.

The lives of rural Americans with opioid use disorder depend on access to treatment, and telemedicine may be an effective tool to improve access. Ultimately, though, for these approaches to succeed, treatment programs in rural primary care clinics may require community outreach, clinician training, insurance coverage, and accessible and affordable technology solutions.

Other HEAL telemedicine research aims to improve health care access for other affected communities, including women who are incarcerated and patients who visit Federally Qualified Health Centers. Future research is needed to better understand the reasons patients don’t consider telemedicine-based medication treatment for opioid use disorder. That knowledge will inform the development of more effective telemedicine referral and engagement strategies to better serve rural and other highly impacted communities.