The way I see it, telemedicine for Suboxone today is sort of like electric cars in the early 2000s. It does exist in some places, and it shows great promise for the future. However, limitations have held it back from becoming the standard of care.
About 20 years ago, while we did have electric cars, they were rare and inefficient. The range was not good, and charging stations were non-existent. Fortunately, car manufacturers created a transitional solution that was and still is a good idea to save gas, use electricity to drive cars, and, at the same time, give the world time to get used to the idea of changing the entire infrastructure of transportation. This solution was a hybrid vehicle. A car or truck that ran on gasoline, but could also make use of an electrical engine and powerful rechargeable battery. The hybrid vehicle can benefit from the best of both worlds. While electric cars are now starting to become more commonplace, we are still in a period of transition that will last for at least a few more years.
I propose that the best solution to Suboxone treatment now might be a hybrid as well. There are problems with Suboxone clinics and with online Suboxone providers alike. If we choose to make use of the best of both types of practice, we can better transition into a future where telemedicine is the predominant form of medical care.
Patients who attend clinics may have issues with privacy and transportation. While healthcare laws protect patient privacy, patients may feel that attending a clinic and sitting in a waiting room is not a very private experience. Additionally, many patients do not have a Suboxone provider or treatment clinic nearby. They may have to travel far and take time off from work. Or, they may not have a method of transportation due to the consequences of their opioid addiction.
While an online Suboxone visit may seem ideal, there are problems there as well. How can treatment providers be sure that the patient is compliant with treatment? Some telemedicine companies have solved the issue of drug screening by having a nurse go to the patient’s home. At this point, the process more resembles a home visit than a telemedicine visit. Another solution is to have the patient go to a lab for drug testing. By having testing done away from the prescriber, there is less control of the process to ensure that they correctly administer the drug test.
While there are companies that provide full Telehealth Suboxone care in states where the law allows this, and they insist that they have ironed out these issues, in practice, it is problematic. There is still great value in a physician sitting in a room with his or her patient to do an in-person evaluation. Meeting with your doctor in person helps to establish trust and an ongoing stable physician-patient relationship. The doctor can also administer the drug test and ensure proper testing protocols and examine the results directly.
Yet, the benefits of telemedicine are undeniable. So, I suggest that we start to integrate some of the benefits of telemedicine into our current traditional practices. For example, when a well-established patient who is stable finds it challenging to make it to appointments because of work or transportation, telemedicine visits can be scheduled between regular in-person visits. Some doctors see their patients every three months and perform a telemedicine visit in the months in between.
I think it is essential for doctors to start to integrate video telemedicine into their practices to some degree so that they and their patients may become comfortable with it. But, I am not so confident that jumping fully into Telehealth at this point for Suboxone treatment is the right thing to do. However, getting to full online Suboxone treatment will not take very long. Indeed, not as long as it is taking to get to electric cars entirely replacing the gasoline-driven car.