America is suffering from a national healthcare crisis. Opioids have become a scourge, cutting a wide and fatal swath through small towns, rural areas, and, increasingly, larger cities across the United States.
The numbers are daunting. There were an estimated 64,000 drug-related deaths in the U.S. in 2016. Life expectancy fell for the second year in a row in 2016, pulled down by another spike in fatal opioid overdoses, according to the National Center for Health Statistics (NCHS).
"I'm not prone to dramatic statements," Robert Anderson, chief of the mortality statistics branch at the NCHS, told National Public Radio last month (December). "But I think we should be really alarmed. The drug overdose problem is a public health problem, and it needs to be addressed. We need to get a handle on it."
The last time the U.S. life expectancy dropped was in 1993 because of the AIDS epidemic. Life expectancy hasn't fallen two years in a row in the U.S. since the early 1960s, according to NCHS.
In 2017, the Trump Administration declared opioid abuse a public health emergency. At the same time, telehealth is emerging as a valuable weapon to confront the rising tide of opioid deaths. “There are a limited number of assets to deploy to solve the issue,” noted Aaron Turner-Phifer, URAC’s vice president, government relations and policy. “While telehealth can certainly be a tool to expand access to care, you are still relying on a relatively limited number of physicians and other professionals to treat opioid addiction.”
Among other actions, Trump’s declaration “eases some of the restrictions around face-to-face interactions that physicians were required to have to prescribe certain prescriptions that go hand in hand with substance abuse,” Turner-Phifer said.
“When you look at the actual absolute numbers in the south or the midwest, being those that are hardest hit by the opioid crisis, telehealth is a logical fit,” said Kylanne Green, URAC president & chief executive officer. People living in relatively remote or underserved areas of the country are already becoming more accustomed to using telehealth in many health regimens. “To the extent that there’s already pretty good acceptance, I think that the extension to trying to look at substance abuse [telehealth treatment options] is a natural one.”
However, without proper safeguards, there’s a risk of overburdening the telehealth community and infrastructure. “You have the potential to degrade the quality of the service being provided,” Turner-Phifer said. Accreditation is the bedrock for maintaining consistently high standards, he said.
One of the greatest challenges when addressing opioid addiction is the need for continuity and consistency of follow-up when providing patient care. “It’s key for pharmacists and other healthcare professionals to maintain a relationship with the patient,” said URAC’s Product Development Principal, Deborah Smith, MN. “I think that’s one of the challenges in telehealth, because some providers are more episodically oriented.” The result? A gap after discharge, or after the episode of care, Smith said.
“Telehealth can be instrumental in expanding the reach of the provider community, and that could be an important step in the continuing management of opioid use,” Smith added.
URAC’s new standards “very specifically address the standard of care expectation,” noted Smith. Accredited companies “are expected to uphold the same usual and customary standard of practice as in a face to face encounter,” she added.
The URAC standards are also designed to ensure that prescribing is safe and consistent with state laws, regulations, and established standards of care. “Continuity of care is an established goal for healthcare services and one we all need to work hard to achieve”, Smith said.
“Accredited telehealth programs are well-positioned to help alleviate this opioid epidemic, even in the most remote parts of the country,” Green said. “I know we all want to play our part in addressing this deadly healthcare crisis.”