Association for Public Policy Analysis & Management

Only a small minority of individuals with substance use disorders (SUDs) receive treatment in the U.S. The shortage of SUD providers, particularly in rural areas, is an important factor. Telemedicine for SUD (“tele-SUD”) involving live video teleconferencing could be a means of expanding access.

Using 2010-2017 OptumLabs data on commercially-insured individuals, we conducted descriptive and multivariate analyses to examine trends in tele-SUD use, the extent to which tele-SUD visits are used alone vs. combined with in-person SUD care, and characteristics of users.

Tele-SUD use grew from 0.62 visits per 1000 individuals diagnosed with SUD in 2010 to 3.05 visits per 1000 in 2017 (compared to 0.91 and 16.59 visits per 1000 for tele-mental health). Only 15% of visits involved psychotherapy. Tele-SUD users were more likely to be male, aged 20-40, have an opioid use disorder diagnosis, have a severe mental health diagnosis, live in a rural area, and live in an area with high median household income, relative to individuals with SUD who did not use tele-SUD. The median number of tele-SUD visits in a year among users was 1 (mean=1.6). 99% of users also received in-person SUD ambulatory visits during the year. We are currently completing analyses of the timing/sequencing of tele-SUD services within SUD treatment episodes.

We find relatively low use of tele-SUD, particularly compared to tele-mental health. Tele-SUD appears to be used primarily in combination with in-person care, rather than as a substitute. The low use suggests a missed opportunity in the context of the opioid epidemic.