Addiction and COVID: Issues, Challenges, and New Telehealth Approaches

Abstract

In recent decades, the United States has seen a substantial increase in the number of people diagnosed with substance use disorder (SUD). Both SUDs and COVID-19 separately have had, and continue to have, a widespread impact on our society. While they are two distinct entities, they are intricately related and have been shown to influence one another. Lockdown mandates intended to enhance public safety produced unintended consequences for people with SUDs by decreasing access to treatment and disrupting their current care. Telehealth could offer a solution to this disruption as its utilization expands the provider’s reach and increases access to treatment in underserved populations, including those with SUDs. The use of telemedicine seems to result in higher rates of patient satisfaction, compliance, and treatment retention rates while maintaining the need for social distancing. Even when pandemic restrictions resolve, telehealth can continue to provide invaluable benefits to individuals with addiction, particularly those in rural America. In summary, ongoing research regarding telehealth delivery and the expansion of telehealth is a byproduct of the pandemic and can advance the American healthcare system beyond the days of COVID-19. This manuscript will review studies regarding the use of telehealth in SUD with the hope that further research within and beyond the COVID-19 pandemic will lead to the increased use of telehealth by those involved in and those receiving care for SUDs.

The Evolution of Telepsychiatry for Substance Use Disorders During COVID-19: a Narrative Review

“…First, using previously established policies and platforms such as the few digital health applications for smoking cessation that have been tested in large, well-designed randomized controlled trials [ 105 ], this shows a lack of a robust evidence base for the further implementation of digital health. Similarly, there are currently no FDA-approved medications for stimulant and cocaine use disorders [ 115 ] which present an important burden in SUD. Second, regulatory and reimbursement frameworks fit to assess novel digital health tools need to be developed.…”

“…It uses tangible reinforcements, such as rewards and prizes, to encourage behavioral changes and ultimately abstinence (e.g., giving a patient a voucher for a negative urine toxicology) [ 114 ]. Since the start of the COVID-19 pandemic, virtually delivered contingency management has been shown to be efficacious for alcohol and nicotine use disorders [ 114 , 115 ]. Examples of virtually delivered contingency management involve urine toxicology completed at outpatient locations with prizes electronically delivered with prepaid gift cards [ 115 ].…”

“…Since the start of the COVID-19 pandemic, virtually delivered contingency management has been shown to be efficacious for alcohol and nicotine use disorders [ 114 , 115 ]. Examples of virtually delivered contingency management involve urine toxicology completed at outpatient locations with prizes electronically delivered with prepaid gift cards [ 115 ]. Another behavioral therapy for substance use involves mindfulness-based interventions, which are usually a combination of mindfulness meditation linked with cognitive and behavioral approaches.…”

Pain Management and Telemedicine: A Look at the COVID Experience and Beyond

“…Additionally, patients who have been transitioned to partial opioid agonists, off opioids altogether, or have limited access to care could be considered as potential candidates for telemedicine appointments. 7,8 It is ultimately up to the provider who has an established patient-physician relationship and best understands the patient's limitations and healthcare needs who can best determine which patient population telemedicine is appropriate for and how frequently it can be utilized for each individual patient.…”

Measuring the Impact of Virtual Communities on the Intention to Use Telemedicine Services

“…This component was examined by several researchers [ 54 , 55 , 56 ], who discovered a substantial positive association between credibility and the quality of information offered, along with a favorable influence on the intention to use e-healthcare services. Moreover, some researchers [ 57 , 58 , 59 ] have proposed that patients’ trust in digital healthcare services is influenced by their perception of the reliability of those services. Hence, the following hypotheses were proposed:…”