In 2018, Tennessee ranked 3rd in the nation for opioid prescription rates per person and had more than 25,000 fatal and nonfatal overdoses.1 While recognized as a serious statewide issue, rural Appalachian regions have the highest rates of opioid use and overdose in the country.2 Furthermore, East Tennessee suffers from a lack of treatment and recovery services and opioid use disorder (OUD) remains undertreated.2,3
Telehealth presents an opportunity for improving access to treatment and recovery support for individuals afflicted OUD. The opportunities were highlighted during the COVID-19 pandemic in Tennessee when Governor Bill Lee issued a series of Executive Orders that lessened or eliminated key regulations pertinent to telehealth.4,5,6,7,8 Subsequently, the Tennessee General Assembly passed time-limited legislation related to reimbursement for telehealth services.9 These changes have already had a measurable impact on the use of telehealth.10 Following the issue of the first of these Executive Orders in mid-March, Blue Cross Blue Shield of Tennessee saw the number of telehealth claims jump to eighteen times the baseline rate during the one month period through mid-April alone.11
The SMART Policy Network will research and compare state policies regarding telehealth and identify best practices for improving outcomes of Tennesseans with OUD beyond the pandemic. Issues to be explored include coverage and reimbursement for telehealth services, licensure for telehealth providers, and patient safety and security.
1 National Institute on Drug Abuse. Tennessee: Opioid-involved deaths and related harms. https://www.drugabuse.gov/drug-topics/opioids/opioid-summaries-by-state/tennessee-opioid-involved-deaths-related-harms. Published April 2, 2020. Accessed July 16, 2020.
2 Moody L, Satterwhite E, Bickel WK. Substance use in rural Central Appalachia: Current status and treatment considerations. Rural Ment Health. 2017;41(2):123-135.
3 Understanding the state of opioid use disorder in the RCORP-ETC Region: 2018-2019. https://tnopioid.utk.edu/rcorp-etc-reports/. Accessed July 17, 2020.
4 Tennessee Executive Order No. 15 (Mar. 19, 2020).
5 Tennessee Executive Order No. 20 (Mar. 26, 2020).
6 Tennessee Executive Order No. 24 (Apr. 4, 2020).
7 Tennessee Executive Order No. 32 (May 1, 2020).
8 Tennessee Executive Order No. 63 (Sep. 29, 2020).
9 Electronic Delivery of Health Care Act of 2020, Tenn. Code Ann. Title 56 § 63-1-155.
10 Sy, S. & Fritz, M. (September 10, 2020). Could the pandemic change addiction medicine for better? Public Broadcasting Services (PBS) News Hour. Retrieved from: https://www.pbs.org/newshour/show/could-the-pandemic-change-addiction-medicine-for-the-better.
11 Wicklund, E. Tennessee Lawmakers Pass New Telehealth Coverage Law – With Limits. https://mhealthintelligence.com/news/tennessee-lawmakers-pass-new-telehealth-coverage-law-with-limits. Published August 13, 2020. Accessed September 29, 2020.
About 400,000 Tennesseans have substance use disorder (SUD). Only 1 in 10 Tennesseans who need treatment for SUD obtain it, mainly due to local provider shortages, long distances between a small number of treatment centers, stigma and cost. Telehealth directly addresses barriers and improves access to care.
Telehealth SMART Team
Professor, UT Knoxville College of Nursing and
Associate Professor, UT Knoxville Department of Public Health
Cedar Recovery and Journey Pureth
SMART Policy Network Graduate Research Assistant
UT Knoxville Master of Public Health student
Director of Substance Misuse Outreach and Initiatives, UT System
Clinical Assistant Professor, UT Knoxville College of Nursing