Telemedicine and Treating Opioid Use Disorder in Rural Populations (On-Demand)-Presentation

Video Transcription

Video Summary

Dr. Greenberg, an addiction medicine physician and medical director of opioid treatment programs (OTPs) in rural Northern California, discusses the implementation and impact of telemedicine in treating opioid use disorder (OUD). He highlights the unique challenges rural patients face, such as transportation barriers, limited resources, and privacy concerns in close-knit communities where anonymity is difficult. Telemedicine, accelerated by the COVID-19 pandemic and regulatory relaxations, offers increased convenience, improved access, reduced stigma, and enhanced follow-up capabilities, including crisis support and asynchronous communication through secure messaging. <br /><br />Dr. Greenberg stresses the importance of telemedicine etiquette and creating individualized treatment plans that adapt to patient circumstances. He notes that while telemedicine may make rapport building more challenging due to reduced nonverbal cues, effective communication and patient engagement remain achievable. Issues like internet connectivity, phone availability, and privacy must be managed carefully. Urine drug screening, often a contentious tool, should be framed as collaborative rather than punitive, with alternatives like saliva testing to preserve dignity and trust.<br /><br />He advocates for a harm reduction model, emphasizing ongoing counseling to address trauma and co-occurring mental illness alongside medication-assisted treatment (MAT). Buprenorphine induction can be done safely via telemedicine, including low-dose home inductions especially in the fentanyl era, with emergency support available if necessary. Dr. Greenberg underscores the need to maintain open access and flexibility to retain patients in care despite setbacks and challenges. Telemedicine and in-person care yield comparable outcomes, making telemedicine a critical tool to close the treatment gap in rural OUD populations.

Keywords

opioid use disorder

telemedicine

rural healthcare

addiction medicine

medication-assisted treatment

buprenorphine induction

harm reduction

COVID-19 impact

patient engagement

privacy concerns