The challenges of telemedicine in rural opioid addiction treatment


While telemedicine is among the federal efforts being used to fight opioid abuse in rural areas, significant challenges remain for both providers and patients.

The U.S. Department of Agriculture recently awarded nearly $1.4 million for five projects in Kentucky, Tennessee and Virginia aimed at opioid abuse. One of them, Roanoke, Va.-based Carilion Medical Center landed $434,182 to deliver healthcare in 12 rural counties in southwest Virginia.

Carilion’s system provides remote psychiatry to patients using a tablet in exam rooms at the office of family physician Robert Devereaux in rural Giles County. Two little-known addiction treatment programs in the next county are nearly 25 miles away, according to a Washington Post story. Many of the patients are of limited means and may not have a car.

The medicines used to treat addiction, however, require complex in-person treatment and monitoring that cannot be done by telemedicine, according to the article. Prescribers of suboxone, a drug used to treat opioid addiction, must be licensed by the Drug Enforcement Administration.

Carilion is encouraging rural doctors to become licensed; the nearest licensed prescriber to Devereaux’s office is 30 miles away.

A bigger problem is reimbursement, the article notes. The grants cover technology implementations, not the treatment, and since neither Virginia nor Tennessee expanded Medicaid under the Affordable Care Act, many patients might not be covered.

The Justice Department recently announced $8.8 million in grants to entities, including the states of Kentucky and Tennessee, to fight opioid addiction. It’s promoting a three-part strategy of prevention, enforcement and treatment that calls for strengthening Prescription Drug Monitoring Programs (PDMPs) and improved data sharing between doctors and pharmacists.