Gov. Charlie Baker signed an executive order on March 15 expanding access to telehealth services for the duration of the Covid-19 crisis. His action has the potential to make Medication Assisted Treatment (MAT) for substance abuse disorder far more accessible, according to several Cape-based addiction specialists.

The governor’s order prevents private insurers from imposing telehealth restrictions more stringent than those outlined by MassHealth, the state’s health care safety net. This means that all insurers are now covering a wide range of telehealth services at in-person rates.

Allie Andersen, chief clinical officer at Gosnold, the Falmouth treatment center, welcomed the new policy. “As far as paying for service,” she said, “they’re currently at the same rates as a face-to-face session, and I’m hoping that they will continue to do that. I think it’s a benefit to the patients.”

Virtual options for behavioral health care, such as substance abuse treatment, teletherapy, and telepsychiatry, have been covered by MassHealth since the start of 2019. But before the pandemic, providers were required to use certain technologies, undergo telehealth-specific training, and “ensure the same rights to confidentiality and security as provided in face-to-face services.” Audio-only telephone conversations were not to be used in isolation.

That changed in March of this year. MassHealth relaxed its requirements for providers, calling for confidentiality and security rights to be maintained “to the extent feasible.” Telehealth training and technology guidelines are waived, as is the rule about audio-only appointments.

In addition, a federal rule that requires all new opioid treatment program patients to undergo a complete physical examination has been temporarily waived by the Substance Abuse and Mental Health Services Administration, except in the case of methadone programs, which are more strictly regulated.

Though some insurance providers covered telemedicine services for behavioral health care prior to the Covid-19 crisis, strict regulations meant that the services gained little traction.

MAT for opioid addiction, a form of outpatient rehab that uses prescription medications alongside counseling and behavioral therapies, may now be conducted exclusively remotely. Duffy Health Center in Hyannis; Gosnold in Falmouth and Cataumet; and Outer Cape Health Services in Provincetown, Wellfleet, and Harwich Port all provide forms of MAT using medications like buprenorphine and naltrexone (the combination of the two is the common therapeutic Suboxone), which reduce cravings for addictive opioids. Such programs usually require new patients to attend weekly appointments until the patient’s condition is stabilized, at which point meetings may become less frequent.

Prior to the pandemic, Gosnold mainly prescribed Vivitrol, a monthly injection of the generic drug naltrexone, which can reduce opioid cravings for up to a month. Now, Andersen says, many patients have switched to an oral form of the medication in order to avoid going into a public place. Though in-office injections are still available, most patients have opted for fully remote treatment.

Duffy Health provides services to people with substance use disorder throughout Barnstable County, as well as those facing housing instability, joblessness, lack of health insurance, and chronic disability. It typically provides MAT for about 330 patients Cape-wide, but that number has increased to 360 since mid-March, when telehealth restrictions were relaxed and in-person visits were severely limited.

Daniel Rodrigues, the assistant director of substance abuse services at Duffy Health, said that the relaxing of federal regulations has made MAT for substance use disorder more accessible to many patients. “Telehealth restrictions have been a real barrier for the folks we’re serving,” he said.

Rodrigues said that retention rates in particular have increased with the breakdown of transportation barriers. While Duffy is committed to providing same-day treatment to anyone seeking it because it can be “life or death,” he said, long commutes mean that weekly in-person appointments have proven difficult to maintain for patients outside the Upper and Mid Cape.

At present, Duffy serves only six patients from the four Outer Cape towns. But Rodrigues said that broader usage of telemedicine services will increase Duffy’s geographic capacity and allow for greater accessibility to Outer Cape residents.

Andersen hopes that telehealth will find a solid middle ground in a post-coronavirus world.

“Patients can make their appointments from their homes, anywhere really,” she said. “We have patients who go out on their lunch break and do it from their cars. It’s allowed a lot more people access from a lot more locations.” While she views this increased accessibility positively, she is also looking forward to increased security standards after the pandemic.

Could telemedicine increase Gosnold’s often waitlisted outpatient capacity in the future? “Absolutely,” Andersen said.

The Mass. League of Community Health Centers reported that “telehealth — particularly telephonic — has quickly demonstrated its efficacy in eliminating patient barriers to treatment, including transportation, finding time for frequent visits, care-giving responsibilities, not having a job that offers flexible, paid time off, limited data plans, and ambivalence about coming into a clinic to engage in care.”

Dr. Matthew Libby at Outer Cape Health Services said that many patients enjoy the convenience of telehealth appointments, but some also miss the in-person experiences of counseling and group therapy. Throughout the pandemic, OCHS has had difficulty obtaining frequent drug screenings. A patient’s internet and cellular connectivity can also pose problems. OCHS currently serves around 200 patients in its Office-Based Addiction Treatment (OBAT) program, a number that has remained stable since before the pandemic.

OCHS expects telehealth will remain “an important part of how we deliver care in the future,” said Libby.

Last week the Mass. Senate unanimously passed the Patients First Act, which requires all insurance providers to cover telehealth services “in any case where the same in-person service would be covered” at the same reimbursement rates for at least the next two years.

“While Covid-19 has stressed healthcare in a myriad of ways, the transition to telemedicine and the expanded practice of providers during the emergency have proven to be extraordinary tools that keep patients healthy, especially in geographically isolated regions like the Cape & Islands,” said Sen. Julian Cyr (D-Truro) in a June 26 press release.

Olivia Weeks’s summer fellowship with the Independent is supported by the Harvard Alumni Association and the Harvard Club of Cape Cod.