It’s time to leverage telehealth to the fullest in the uphill battle against the tenacious opioid epidemic plaguing the United States, leading experts say. From local lawmakers to their federal counterparts on Capitol Hill, there’s a growing awareness telehealth is ready to take center stage in the fight.
While some regulatory, technical and efficacy questions remain to be addressed, the severity of the opioid crisis is putting a spotlight on telehealth as a means of care delivery. Now, it’s time for telehealth to show what it can do, says Aaron Turner-Phifer, vice president, government relations and policy at URAC, a nonprofit accreditation organization based in Washington, DC.
“This is a tremendous opportunity for the telehealth providers and the advocates of telehealth to demonstrate the value and impact this tool can have in the delivery of services, because folks right now are stretching to respond to a crisis,” says Turner-Phifer. “They're willing to deploy tools that may not have the evidence base of other approaches.”
While experts criticize the bill as lacking the “urgency, breadth and steady long-term funding” needed to end the opioid crisis, they agree it’s a step in the right direction.
Turner-Phifer identifies some of the drivers generating momentum in Washington, D.C. “Over the last ten months, maybe the last two years, some of the major telehealth related pieces of legislation have gotten tied into some of these larger budget deals, he says. “A lot of the things that were part of a comprehensive telehealth package have been taken in small bites through some of these other approaches.”
“CMS has done some things under their authority that has paved the way for an increased adoption and payment in telehealth,” he adds. “It's been a series of small evolutions in both legislation and regulation.”
As cost projections of the opioid epidemic increase, requests for sustained, additional funding to control the epidemic will continue. In 2017, health care reform efforts aimed to provide $45 billion in funding to states, distributed over a decade, to fight the opioid epidemic—a figure that healthcare professionals worried was much too low.
There has also been heated conflict surrounding the issue of regulating opioid prescriptions. For example, earlier this year CMS proposed a rule limiting opioid prescriptions that would restrict opioid doses to Medicare patients to the equivalent of 90 milligrams of morphine per day. It met with strong opposition from a wide array of academics, doctors, and editors of pain journals claiming the proposed rule constitutes overreach by CMS into medical treatment and would carry serious consequences for the 1.6 million Medicare beneficiaries who reached that threshold for at least one day in 2016.
Broadly speaking, states have generally outpaced federal regulators in terms of taking active steps to check and reverse the epidemic via telehealth and other applications.
West Virginia, New Jersey and several other states hardest hit by the crisis are leading the way. For example, earlier this year, New Jersey’s attorney general created a new office to specifically fight the opioid crisis. The Office of the New Jersey Coordinator of Addiction Response and Enforcement Strategies (NJ CARES), will oversee addiction-fighting efforts across the state, with data analysis and telehealth playing a key role.
In March, West Virginia’s governor signed the Opioid Reduction Act which includes provisions advancing the use of telehealth in the state. It also requires the prescriber to inform the patient of the quantity of the opioid being prescribed and the opportunity for the patient to fill at a lesser quantity. Prescribers must also inform the patient of the risks associated with the prescribed opioid.
Bottom-line: While the fight against the opioid health crisis has inspired a rare, relatively bipartisan spirit on Capitol Hill, overlapping state regulations, funding issues, and debates about dosage and prevention tools and tactics continue to hinder an even swifter, broader response.