Is Digital Health Meeting Its Goals in Substance Abuse Treatment?

A new study finds that a third of providers surveyed are using digital health to treat OUD and substance abuse, yet the tools aren't being used to expand treatment or reach those who need help.

Digital health tools are increasingly becoming the weapon of choice for healthcare providers treating  patients living with opioid use disorder (OUD), according to new research from several New England healthcare organizations.

But that weapon isn't being used as well as it could be.

More than a third of health systems with accountable care organization contracts are using at least one type of technology, including remote patient monitoring and on-demand support tools, says a study recently published in JAMA Network Open. Oftentimes those tools are used alongside the traditional treatment path of in-person care, suggesting that those using the technology are doing so because they can, rather than because they need to.

"Our results suggest that digital health technologies for OUD are more likely to be deployed by organizations with relatively robust traditional SUD treatment resources," the study, conducted by researchers from Harvard, Yale, Dartmouth, UnitedHealthcare and Beth Israel Deaconess Medical Center, concluded. "As such, the technology appears to complement existing SUD treatment resources rather than substitute for unavailable SUD treatment resources."

OUD and substance abuse combine to form one of the nation's most devastating health concerns, one that has been increasing in the wake of the pandemic. The issue is complicated by the fact that many patients conceal their problems or avoid medical treatment, as well as the fact that many are also living with behavioral health issues in need of treatment.

The study, drawn from a 2021-22 survey of 505 ACOs, of which 276 responded, finds that 33.5% of those responding are using some type of technology, such as virtual mental health therapy and tracking, virtual peer recovery support, and digital recovery support for adjuvant cognitive behavioral therapy (CBT). Just as important, that percentage increased among providers with a dedicated addiction medicine specialist or a registry to track mental health.

That's an important distinction. Digital health has long been considered an import platform to reach patients who either can't or won’t access healthcare providers for treatment. This means providers can and should be using these tools to connect with people who they might otherwise not treat or who would skip treatment. The study suggests that providers are using the technology to bolster care for patients they're already treating, and that providers who already focus on OUD and substance abuse care are using the tools.

"Organizations with substantial resources may have the ability to effectively integrate digital services," the study reported. "On one hand, organizations can extend treatment provided by their clinicians through mobile tools to track mental health symptoms remotely. On the other hand, technologies could substitute for insufficient SUD resources to meet clinical demand for patients with OUD. If technologies are primarily available in organizations with robust SUD treatment resources, then they are not yet reaching their full potential to advance access to care for patients with unmet needs in organizations without traditional treatment alternatives."

Therefore, for digital health to really have an impact on OUD and substance abuse treatment, it has to be used to reach those not receiving treatment. As well, this technology has to be made available to more healthcare providers who haven't traditionally treated patients with OUD or substance abuse issues but who can, including primary care providers and rural and community health clinics.

The study offers suggestions for expanding use of the technology to more organizations, as well as addressing health equity concerns.

"Our findings suggest a mismatch between need and deployment," researchers pointed out. "Organizations with fewer SUD treatment resources were less likely to adopt emerging technologies. To address this mismatch, policy initiatives could focus efforts on overcoming barriers to technology implementation in high-need, resource-limited healthcare settings. For example, policy makers and payers might test policies and reimbursement schemes that support health care organizations without local SUD treatment resources to integrate digital health technologies for OUD into their practices and workflow."

"Initiatives to advance the uptake of technologies may address costs, knowledge, user engagement, organizational culture, leadership, interoperability, and data security concerns," the study continued. "Training and education for patients and clinicians may be a productive avenue to increase adoption. For example, Kaiser Permanente used both clinician referrals and direct-to-patient approaches to drive service use during a large-scale integration of digital mental health technologies. Future efforts may require investing in trained staff, such as digital navigators, to support patients and clinicians to overcome technological, workflow, and digital literacy constraints. Digital navigators offer an opportunity to overcome both patient- and staff-level barriers to technology use even in low-resource settings."

The implication is that while digital health is being used to address the substance abuse crisis, it could be used much more effectively, not only as a complement to existing programs but as a platform for more providers to reach more people in need of help.