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The US opioid and stimulant epidemics create expanding need for substance use disorder (SUD) treatment.
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COVID-19 has imposed new demand for telehealth, remote monitoring, and digital health interventions for SUD to enhance clinical practice.
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Technology offers potential to mitigate health-related disparities in SUD care by addressing the needs of diverse patient groups and increasing access to care.
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A strong evidence base supports the feasibility and potential effectiveness of technology-based
Practical Technology for Expanding and Improving Substance Use Disorder Treatment: Telehealth, Remote Monitoring, and Digital Health Interventions
Section snippets
Key points
Provider Visits
Patients use telehealth to connect to clinicians, peer recovery coaches, nurses, pharmacists, and prescribers for opioid use disorder (OUD).1 Strategies for real-time, synchronous communications can include telephone (audio-only) and 2-way video. Telehealth software can be stand-alone or integrated with an electronic health record. Many telehealth-ready software platforms comply with the Health Insurance Portability and Accountability Act (HIPAA), including free and subscription services (eg,
Remote monitoring
On-site testing is an obstacle in telehealth and for patients with mobility, transportation, work, or childcare challenges–disproportionately affecting underserved populations and further exacerbating health disparities. Testing is critical in one of the most effective SUD interventions, contingency management, which provides monetary incentives contingent on verified substance abstinence.21 Frequent random substance tests are generally recognized as more effective than predictable testing,22
Digital health interventions
Many health and wellness Web sites and smartphone apps are marketed to treat SUD.8 Unfortunately, most are of poor quality and lack research validation,13 whereas researchers have developed many digital tools with outcome data but not availability or support.14 There are, however, several technology-based SUD interventions that are evidence based and freely or commercially available.21
Strengths of Technology-Based Approaches
Technology offers many advantages for providers and patients. Patients have greater access to tools and services, avoiding objective obstacles, including transportation limitations, work schedule conflicts, and childcare disruptions. Technology-based treatments can be delivered even to patients who lack smartphones, because Medicaid covers phones and data plans under the Affordable Care Act.59 Convenience for providers is enhanced as well, with work-from-home and flex-time scheduling.
Summary
Most people with SUDs do not seek treatment. The pandemic has created other obstacles due to social distancing and other stressors that amplify the incidence of SUD. Patients with SUDs need improved access and acceptability of effective SUD treatment. Telehealth, remote biometric monitoring, and digital health interventions are transforming the delivery of SUD treatment. Technology has the potential to greatly expand access to both usual care and complementary evidence-based interventions.
Clinics care points
Technology-assisted SUD care is available, feasible, and effective in the era of the opioid and stimulant epidemics, COVID-19, and beyond. Providers have multiple technology options to support telehealth and adjunctive digital health interventions for SUD including evidence-based smartphone apps. Patients may accept, like, and even prefer services and tools that are technology based. The effectiveness, quality, and security of technology-based services and tools should continue to accumulate
Disclosure
This work was funded by the NIH/NIAAA Small Business Innovative Research and Small Business Technology Transfer Grants R43AA026234, R44AA026234, and R44DA055396. The funding source was not involved in the study design, research, or the preparation of the article. Dr M.M. Sweeney is now employed by the National Institutes of Health, National Institute of Mental Health. This article was prepared while Dr M.M. Sweeney was employed at Johns Hopkins University. The opinions expressed in this article
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