Providers warn telehealth can prevent drug abuse detection

Three-quarters of doctors said they believed telemedicine visits limit their ability to determine if patients are at risk or if they are currently abusing prescription drugs, according to a new study.

Service providers are concerned that substance abuse issues are eluding virtual care as patients experience more stress and mental illness, according to Health Trends 2021 Quest Diagnostics. report released in November.

“Telemedicine is important,” said Dr. Harvey Kaufman, Senior Medical Director and Program Manager for Health Trends Research at Quest Diagnostics. “It stimulates interaction that might not otherwise happen when offices are closed, and also plays a role in facilitating the exchange of information between doctor and patient. But it cannot replace everything that happens in person.”

Overdose deaths, mainly attributable to fentanyl use, rose to 96,779 (up 30%) between March 2020 and March 2021, Centers for Disease Control and Prevention study said.

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This led the Government Accountability Office and other organizations to urge the federal government to focus on drug abuse control in addition to the COVID-19 response.

In a survey of more than 500 government licensed doctors commissioned by Quest Diagnostics, 71% said the pandemic has worsened the prescription drug crisis, and 76% expect drug overdose deaths to continue to rise even as the pandemic abates.

Virtually all, 94% of primary care physicians surveyed reported seeing more patients experiencing stress, anxiety, or other mental health problems due to the pandemic.

Only half of doctors are confident they can recognize signs of prescription drug abuse through telemedicine interactions, compared with 91% who are confident they can detect abuse through interactions with patients in the office.

Due to the lack of personal visits, 67% of doctors reported that they were afraid to miss signs of drug abuse or drug use disorders in one or more of their patients during a pandemic.

However, some health systems have launched their own substance abuse telemedicine programs amid the pandemic surge, and payer investment in virtual drug abuse treatment has increased.

Even before the pandemic, telehealth made a huge contribution to the treatment of mental illness and substance use disorders, says Alliance for Connected Care Executive Director Christa Drobak.

In 2018, Congress passed legislation for the first time allowing Medicare members with substance use disorders to be treated with telehealth.

While a physical visit to a lab is necessary to formally confirm someone is abusing drugs, Drobak said doctors can ask patients the same questions about their history and current activities through telemedicine as in face-to-face to identify possible substance abuse. … They can also provide basic counseling and support services virtually to drug abusers.

“The bias against telehealth is such that you can’t get as much out of telemedicine as you do in person,” she said. “But then, when people do a telemedicine visit, their perception changes, and they like it more, and they believe they can get more out of the virtual visit.”

In the early months of the pandemic, the volume of drug clinical trials dropped by 70%, which contradicts most of the responses from doctors who believe drug clinical trials are critical to preventing substance abuse.

Doctors and patients need to work with each other to decide when to use telemedicine and when to make personal visits, especially to identify and test for drug abuse, Kaufman said.

“There is a difference in rendering people on screen and in real life,” he said. “And to do a drug test, you usually need to evaluate a urine sample for drugs. It can’t be virtual. “

Data from more than 475,000 anonymous test results from 2020 shows that nearly half of all patients tested by Quest Diagnostics showed signs of drug abuse, and a quarter showed signs of a combination of drugs.

Doctors need advice on finding a balance between remote and inpatient care in order to provide compassionate care to their patients, Kaufman said. About 80% of respondents said they need more information on how to manage prescription drug dependence in general.

“They are looking for educational support to understand how best to use the various resources available, be it telemedicine, face-to-face visits or urine drug testing, to better cope with this epidemic as part of a pandemic,” Kaufman said.

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