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Treating Substance Use Disorder via Telehealth


Can substance use disorder (SUD) be effectively treated via telehealth? Edward Kaftarian, MD, Psych Congress Steering Committee Member, shares his insights on the clinical, legal, and technological factors that impact virtual care for SUD. From navigating the Ryan Haight Act to ensuring patient confidentiality and assessing withdrawal symptoms remotely, Dr Kaftarian discusses how providers can optimize telehealth while maintaining high-quality care.

For more expert insights for your virtual practice, visit the Telehealth Excellence Forum here on Psych Congress Network.


Read the Transcript

Psych Congress Network: Can substance use disorder be treated via telehealth? If so, what unique considerations do virtual providers need to keep in mind when treating patients with SUD remotely?

Edward Kaftarian, MD: Substance use disorders, thinking clinically here, can be treated virtually. Legally, we have to consider the Ryan Hay Act because a big part, maybe the biggest part of treating, for example, opioid use disorders is getting our patients on proven, evidence-based medications that not only help our patients get better, but also keep them in treatment retention. So, like it or not, these medications, they work and they are definitely one of the most important tools that we have. The problem is that we need to be supported by appropriate supportive law around it and regulation around it, and that involves allowing controlled substances to be prescribed over telehealth.

Some of the things that we need to keep in mind are if we're prescribing a controlled substance: is it legal to do so? Have you checked the boxes that are necessary if an in-person visit is required? If it ultimately is required, and we don't know that yet because we are waiting for the Ryan Haight Act to resolve. But if we do have to do that, then we have to consider how are we going to see our patient in person before we prescribe the controlled substances.

As far as other clinical things to consider, when you're seeing a patient on remotely via video conference, like everything else, you need to establish rapport with a patient. You want to make sure that the audio and video are really clear, that people can see each other clearly, and that your patient is in a confidential space. Confidentiality is, of course, very important in any setting. But with virtual, you got to make sure that you're on a compliant platform. Also, sometimes people that have substance use disorders have a hard time finding confidential space. Make sure that your appointment is confidential. For example, if they're in a sober living house with lots of activity in the background and confidentiality concerns, you need to find a better space.

As for other considerations, you want to make sure that you're paying attention to whether the patient is intoxicated or they're in withdrawal. You're going to have to pay attention to maybe some subtle physical findings, like maybe some clinicians might not put in enough effort to really take a moment and see what's on the camera right in front of them. That could be a dilated pupil, a myotic, a small pinpoint pupil, depending on the drug. They could be sweating, they could be shaking, they could be looking sad, they could be looking hyperactive. Really paying attention to the physical side of things is especially important when you're treating substance use disorders via telehealth, which is why it's really important to have clear video so that you can see in detail. Sometimes the video can even be an advantage over in-person appointments. Sometimes there are people like to talk about the potential disadvantages, but one advantage is with video, you can zoom in depending on the camera, so if you notice that the person appears intoxicated, some technologies may allow you to zoom into their eyes and see what kind of pupil you're dealing with here. Or you can see their skin and what kind of quality of skin, if they're sweating or if there's anything physically wrong. You can sometimes have an advantage with the camera over your naked human eye. So those are some of the considerations.


Edward Kaftarian, MD, is a preeminent authority in the field of Telepsychiatry. He holds a distinguished seat on the Telepsychiatry Committee of the American Psychiatric Association and is a member of the Steering Committee for PsychCongress, the United States' largest independent mental health educational conference. Additionally, Dr. Kaftarian is a prominent speaker on the rules and regulations governing telehealth. Dr. Kaftarian completed his psychiatry training at the prestigious Johns Hopkins University and holds board certifications in Psychiatry, Forensic Psychiatry, and Addiction Medicine.


 

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