Using Telehealth to Expand Treatment Access for Veterans with Opioid Use Disorder

Takeaway: This study is expected to improve access to opioid use disorder (OUD) treatment by developing and pilot testing a novel telehealth treatment delivery intervention.

With the ongoing national opioid epidemic, the prevalence of opioid use disorder (OUD) among Veterans has increased and many Veterans with OUD experience serious and preventable harms including overdose and suicide. Increasing access to treatment, including to the medication buprenorphine, may help prevent these harms. However, historically, only about one-third of Veterans with OUD receive evidence-based treatment. Telehealth interventions have been developed in VA to extend provider capacity and reach and increase treatment access to mental health and other chronic disease care, but minimal research has been conducted on telehealth models for substance use disorders. COVID-19 has dramatically altered the telehealth landscape, but there is still little understanding of how telehealth is being used in OUD and other substance use disorder care – and how it should be optimized to improve care. Further research is needed to inform OUD telehealth models that can be scalable across facilities, examine impact on treatment use, and determine where telehealth should be prioritized to maximize impact. 

This ongoing study (April 2019 – March 2024) seeks to gather information from patients and clinicians to help develop and pilot a telehealth intervention among Veterans and better understand the VA OUD treatment landscape to understand where to further optimize care. Investigators will:

• Conduct semi-structured interviews with patients and clinicians in order to understand: experiences and variation with telehealth treatment; perceptions of how telehealth can address the OUD treatment gap; barriers/facilitators to use; and ways to improve telehealth for OUD and other substance use disorder care in the future.
• Integrate qualitative findings to help refine and pilot-test a telehealth intervention for Veterans with OUD. 
• Examine variation in OUD treatment use (comparing different forms of telehealth use with in-person treatment) and outcomes across VA to understand where and for which Veterans telehealth should be prioritized to improve outcomes.

Methodology

This mixed-methods study integrates qualitative data from Veterans and other stakeholders, pilot intervention data, and quantitative national VA data factoring in facility-level variation to help develop, test and characterize ways to use telehealth in order to improve treatment access and outcomes for Veterans with OUD and other substance use disorders.

Findings

There are no findings to report at this time.

Anticipated Impact

This research is expected to help develop and improve different telehealth treatment models and to better understand the quality of telehealth care and outcomes, in order to both increase access and improve outcomes for Veterans with opioid and other substance use disorders.

Principal Investigator

Lewei (Allison) Lin, MD, is part of HSR&D’s Center for Clinical Management Research (CCMR) in Ann Arbor, MI; Dr. Lin is supported by an HSR&D Career Development Award.

Publication

Lin LA, Fernandez A, and Bonar E. Telehealth for substance-using populations in the age of coronavirus disease 2019: Recommendations to enhance adoption. JAMA Psychiatry. December 1, 2020;77(12):1209-1210.

View study abstract

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