ANNAPOLIS (April 01, 2017)—A bill that could expand telemedicine to include counseling for substance abuse disorders, which could help thwart the ballooning heroin-opioid epidemic in the state, is advancing in the Maryland General Assembly.
Telemedicine, or the use of virtual tools like video chats to provide health care services, has grown rapidly in recent years. In 2015, about 15 million Americans used telemedicine, a 50 percent increase from 2013, according to the American Telemedicine Association.
Although some health insurance providers do offer telemedicine for the treatment of substance abuse disorder, the bill, sponsored by Delegate Joseline Peña-Melnyk, D-Anne Arundel and Prince George's, would ensure that this would include counseling for addiction treatment.
"Counseling is a critical component of the recovery process, and works hand in hand with medication-assisted treatment," wrote the Community Behavioral Health Association of Maryland in testimony in support of the bill. "This bill would help ensure the most efficient use of clinicians who are paneled with commercial (health insurance) carriers by allowing them to deliver counseling services through telehealth."
There has been a growing push for the the adoption of telemedicine for the treatment of substance abuse disorders, said Yngvild Olsen, the director of a Baltimore outpatient substance use disorder treatment program.
However, some Medicaid regulations have hindered reimbursement of telemedicine for substance-abuse counseling services, Olsen said, adding that if regulations are clarified, Maryland could begin seeing a more widespread adoption of the treatment method.
"This is something that there is a significant amount of interest in because of the lack of behavioral health counseling and other behavioral health services in many areas of the state," Olsen told the University of Maryland's Capital News Service.
Opioid-related deaths in Maryland have doubled from 529 in 2011 to 1,089 in 2015, according to the Department of Health and Mental Hygiene.
Pockets in the Eastern Shore and Western Maryland have had trouble attracting enough health care providers to treat the problem there, Olsen said.
Moreover, the U.S. Health Resources and Services Administration has designated parts of Baltimore City and all of Harford County as areas where there is a shortage of health professionals, specifically for mental health.
Although other states have begun adopting a more widespread use of telemedicine for opioid-heroin substance abuse treatment, Maryland has only a few pockets where these services are available, Olsen said.
The first telemedicine program to treat addiction in Maryland started with a partnership between the University of Maryland Medical Center and the Wells House, a Hagerstown, Maryland, drug treatment program.
After one of the Wells House's doctors retired, the staff were looking for a solution to keep up with the "ever-increasing" demand, said Paul Smith, the telemedicine program coordinator.
So they enlisted the help of University of Maryland Medical Center doctors who remotely meet with patients and prescribe them medication to treat their addictions by video chatting through their television screens, Smith said.
"It's so versatile," Smith said. "They can literally plug in here in a matter of seconds."
Wells House prescribes medication for about 30 to 35 patients per week using this technology on average, Smith said. Since the program's launch in 2015, the University of Maryland Medical Center has expanded its partnerships to include the Garrett County Health Department to offer similar services there, he added.
Recent studies have shown that telemedicine can be an effective way to treat substance-abuse disorders.
West Virginia University physicians recently conducted a study to determine whether telemedicine could provide similar outcomes as in-person treatment for patients in medication-assisted treatment programs.
Doctors remotely met with 46 patients in 30-minute group sessions to prescribe them buprenorphine, an opioid medication, by videoconferencing, and met with 54 patients face-to-face. Both groups followed these sessions with an in-person hour-long therapy group.
In the telemedicine group, 49 percent achieved 90 consecutive days of abstinence, compared with 37 percent in the in-person group.
Wanhong Zheng, a doctor who worked on the project, said expanding programs like these could be especially helpful for those with substance abuse disorders living in rural areas, where some patients have to drive up to five hours once a week just to go to a clinic.
This lack of treatment availability, one of the many challenges those hoping to treat an opioid addiction face, can be overcome by expanding telemedicine programs, Zheng said.
Maryland's House of Delegates passed the bill and the state Senate is planning to hold a hearing on it April 4.