Telemedicine along the cascade of care for substance use disorders during the COVID-19 pandemic in the United States. (1st January 2023)

• Record Type: Journal Article
• Authors: Lin, Chunqing; Pham, Huyen; Zhu, Yuhui; Clingan, Sarah E.; Lin, Lewei (Allison); Murphy, Sean M.; Campbell, Cynthia I.; Sorrell, Tanya R.; Liu, Yanping; Mooney, Larissa J.; Hser, Yih-Ing
• Is Part Of: Drug and alcohol dependence. Volume 242(2023)
• Publication Date: 2023-01-01
• Subjects: Telemedicine -- Substance use disorder -- COVID-19, Healthcare services; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2022.109711
• Languages: English
• ISSNs: 0376-8716

Abstract

Abstract: Background: The COVID-19 pandemic has changed the landscape of healthcare service delivery. This review aims to describe telemedicine-delivered substance use disorder (SUD) treatments and services along the cascade of care in the U.S. after the start of the COVID-19 pandemic. Methods: A literature review was conducted on PubMed, Embase, Web of Science, and Cochrane Library (Wiley). English-language articles that describe any healthcare services for patients with SUDs using telemedicine in the U.S. since the onset of the COVID-19 pandemic were identified (N = 33). We narratively summarized telemedicine-based service provision along the cascade of SUD care, such as screening/assessment, prescription, monitoring, recovery support, and other services. Results: Soon after the onset of COVID-19 and mandated restrictions, cadres of healthcare providers from different specialties mobilized to ramp up video- and audio-based services to remotely treat patients with SUDs. Medication prescription (48.5%) and individual counseling (39.4%) were the most frequently reported services delivered via telemedicine. Other steps of SUD care delivered by telemedicine characterized in our review included SUD screening and assessment (30.3%), induction (21.2%), medication management (27.3%), monitoring (27.3%), recovery support (15.2%), and referral (24.2%). Feasibility issues and challenges to implementing telemedicine included patients' lack of access to technology and health insurance coverage, providers' capacity limits and concerns, and clinics' financial and office-space constraints. Conclusion: The COVID-19 pandemic has offered a window of opportunity to advance telemedicine expertise by formalizing clinical guidance and routinizing provider in-service training in virtual SUD treatment. Findings suggest enhanced efforts to reduce disparities in telemedicine-based services. Highlights: A wide range of telemedicine services has been delivered in the U.S. during COVID to treat substance use disorders (SUDs). Medication prescription and individual counseling were the most frequently reported telemedicine-delivered services. Patients' lack of access to technology was the most prominent barrier to delivering telemedicine for SUD. Supportive services such as stable housing and health insurance are warranted to reduce disparity in telemedicine services.