Bridging the Gap: Telemedicine as a Path to Primary Care Pharmacotherapy for Opioid Use Disorder
Pharmacotherapy supports people with opioid use disorder (OUD) on their path to recovery. Also known as Medications for Opioid Use Disorder (MOUD) or Medication Assisted Treatment (MAT), it involves prescribing an FDA-approved medication such as buprenorphine to decrease the cravings and the fear of withdrawal that drive opioid use. It is one of the most effective evidence-based treatments for OUD.
Patients may begin MOUD in a variety of settings. Initial treatment generally occurs in an inpatient or intensive outpatient setting, with 3-5 times/week contact including therapy and social supports in addition to medication. After several weeks or months in this initial phase, visits are spaced out and patients are prepared to transition back to their lives as parents, students, employees, and community members. This transition can be accompanied by the risk of exposure to people or places that make opioids available to the patient. Therefore, continuing pharmacotherapy is critical to keeping the cravings for opioids at bay. Patients who have not been using have also lowered their tolerance and are at increased risk of overdose and death if they do use.
Access to maintenance MOUD is often limited in rural primary care practices. The historic proliferation of pill mill practices by physicians who profited from the addiction of community members has created a lingering skepticism toward PCPs who may be interested in responsibly treating patients. These attitudes are understandable, but we cannot allow them to become a barrier to recovery for patients. PCPs in rural communities also struggle with meeting the demands of a very large practice, often without any of the support we have come to expect in urban practices.
The bridge approach provides:
- the community time to heal and develop trust in a new generation of physicians
- physicians time to become trained in MOUD and build the care management infrastructure into their practice that is necessary to support chronic behavioral health conditions like OUD
- patients with local access to the medication that is critical to their recovery and survival
A crucial element of a bridge program’s success is that the providers giving temporary support be engaged with the community before and during the program. Engagement includes periodic visits to the community to meet with PCPs, treatment programs, patients, and community members. This exposure builds mutual understanding and respect that ultimately creates a new foundation of trust on which to rebuild local access to care.
In this webinar, Holly Russell and Michele Lawrence of the UR Medicine Recovery Center of Excellence discuss telemedicine MOUD as a bridging strategy. They go through key questions involved in implementing a program, including:
- How do we build the bridge?
- How do we operate the bridge?
- What is the future we are bridging to?
The webinar will include a discussion/Q&A period. We hope you can join us and look forward to your ideas and questions.
Holly Russell, MD, MS, is Assistant Professor of Family Medicine at the University of Rochester Medical Center. Dr. Russell is board certified in Addiction Medicine and is the founder and director of the Addiction Medicine program at Highland Family Medicine. For the last three years she has been working on a project looking at how to expand access to treatment for opioid use disorder within primary care settings including the use of telemedicine technology.
Michele Lawrence, MBA, MPH, is Co-Principal Investigator for the University of Rochester’s Recovery Center of Excellence and an Assistant Professor of Psychiatry and Community and Preventive Medicine. She has worked closely with rural Appalachian communities for over 18 years, creating financially viable hospitals, primary care, and behavioral health programs that partner with each other to improve the health of these communities and all of their residents.