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Abstract: More than half of individuals admitted for specialty substance use disorder treatment in California identify stimulants as their primary or secondary drug, yet many people who use stimulants do not seek treatment. Numerous studies have shown that contingency management (CM) is the most effective treatment for stimulant use disorder. California’s innovative Recovery Incentives Program is a groundbreaking initiative that benefits California and serves as a potential blueprint for other states. In this webinar, Drs. Freese and Urada will delve into the program’s achievements and challenges by providing an overview of the Program, and preliminary quantitative and qualitative evaluation findings. Presenters will talk about the connection to technology and the potential for telehealth implementation in the future. Time will be provided for Q&A and discussion with the audience.  

Abstract:

The COVID-19 pandemic has changed the landscape of healthcare service delivery. This review, supported by the Greater Southern California Node and the Telemedicine Special Interest Group (SIG) of the NIDA National Drug Abuse Treatment Clinical Trials Network (CTN), aims to describe telemedicine-delivered substance use disorder (SUD) treatments and services along the cascade of care in the U.S. after the start of the COVID-19 pandemic.

A literature review was conducted on PubMed, Embase, Web of Science, and Cochrane Library (Wiley). English-language articles that describe any healthcare services for patients with SUDs using telemedicine in the U.S. since the onset of the COVID-19 pandemic were identified (N = 33). We narratively summarized telemedicine-based service provision along the cascade of SUD care, such as screening/assessment, prescription, monitoring, recovery support, and other services.

Soon after the onset of COVID-19 and mandated restrictions, cadres of healthcare providers from different specialties mobilized to ramp up video- and audio-based services to remotely treat patients with SUDs. Medication prescription (48.5%) and individual counseling (39.4%) were the most frequently reported services delivered via telemedicine. Other steps of SUD care delivered by telemedicine characterized in our review included SUD screening and assessment (30.3%), induction (21.2%), medication management (27.3%), monitoring (27.3%), recovery support (15.2%), and referral (24.2%). Feasibility issues and challenges to implementing telemedicine included patients’ lack of access to technology and health insurance coverage, providers’ capacity limits and concerns, and clinics’ financial and office-space constraints.

Conclusions: The COVID-19 pandemic has offered a window of opportunity to advance telemedicine expertise by formalizing clinical guidance and routinizing provider in-service training in virtual SUD treatment. Findings suggest enhanced efforts to reduce disparities in telemedicine-based services.