Virtual Care for Substance Use: A Hub for Health Care Providers

Introduction

Virtual care is reshaping how health care is delivered, including for pregnant and postpartum patients facing substance use disorders (SUDs). With the challenges of stigma, access, transportation, and privacy, digital platforms offer accessible, compassionate, and integrated care models. This hub is designed to guide health care professionals in providing high-quality, equitable, and patient-centered virtual care for individuals with substance use disorders across the perinatal period.

Whether you're a seasoned provider or new to virtual health, this hub will help you to consider how to use virtual care for screening, diagnosing and treating SUDs in ways that reduce barriers, promote engagement and improve outcomes for patients and their families.

Key Concepts and Definitions

Understanding the foundational terms is essential when delivering virtual care in the context of SUDs. Here are a few you’ll encounter often:

Substance Use Disorders (SUDs)

Chronic conditions characterized by compulsive use of substances despite harmful consequences to health and quality of life. Pregnancy presents additional complexities due to the impact of fetal growth and development, as well as the health of pregnant patients.

Telemedicine

Delivery of clinical services, led by the provider, using video conferencing or phone. It often takes place “live” where both parties are present at real-time and real-time interactions take place.

Virtual Care

Encompasses telemedicine and all remote digital health tools, including web-based tools, texting, apps, remote monitoring, and AI-assisted screenings.

Hybrid Care Model

Combines in-person assessments with virtual follow-ups for flexibility and accessibility.

Opioid Agonist Therapy (OAT)

A cornerstone of treatment for opioid use disorders, utilizing medications such as methadone or buprenorphine.

Overview

Substance use during pregnancy presents complex clinical and social challenges, often compounded by stigma, geographic isolation, transportation difficulties, and concerns about privacy or involvement with child protection services. These barriers can delay care or discourage individuals from seeking help—placing both pregnant patient and fetus(es) at risk for adverse health outcomes. Virtual care has emerged as a transformative solution, offering flexible, patient-centered, and accessible models for screening, diagnosis, treatment, and postpartum support. Through hybrid care models, telemedicine, and mobile tools, healthcare providers can engage patients in safe, discreet environments—whether at home, in rural communities, or in supportive housing. When supported by training, infrastructure, and trauma-informed, culturally sensitive practices, virtual care can reduce disparities and improve outcomes by fostering trust, continuity, and long-term recovery. Hybrid models can also blend in-person visits with virtual follow-up for SUDs, ensuring comprehensive prenatal and addiction support through multidisciplinary teams.

For clinical practice guidance related to substance use during pregnancy, please refer to the SOGC’s Clinical Practice Guidelines on Substance Use in Pregnancy, Screening and Counselling for Alcohol Consumption During Pregnancy, Cannabis Use Throughout Women’s Lifespans – Part 2: Pregnancy, the Postnatal Period, and Breastfeeding and Opioid Use Throughout Women’s Lifespan: Opioid Use in Pregnancy and Breastfeeding .

Requirements to Provide Virtual Care for Substance Use During Pregnancy

Providing virtual care for substance use, during pregnancy, requires careful planning, appropriate technology and human resources infrastructure, and a patient-centered approach. Here are some basic requirements to ensure safe, effective, and equitable care delivery:

Technology and Infrastructure

  • Secure telehealth platform: Compliant with privacy regulations and supports video, phone or messaging functions.
  • Reliable internet and hardware: Both providers and patients need access to stable internet, smartphones, tablets, or computers.

Privacy and Safety Measures

  • Confidential spaces: Ensure patients have access to private environments for virtual sessions with videoconferencing, or offer phone-only options if video is not safe. It is important to be aware that videoconferencing with an artificial background can obscure other people in the vicinity of the virtual care screen which is important to keep in mind for privacy and confidentiality
  • Safety protocols: Screen for intimate partner violence (IPV) and develop emergency procedures for high-risk patients.
  • Consent and confidentiality: Clearly communicate the limits of virtual care and obtain informed consent, including the ability to confirm identification of the correct patient if not videoconferencing and the awareness that videoconferencing with an artificial background can obscure other people in the vicinity of the virtual care screen which is important to keep in mind for privacy and confidentiality

Clinical Readiness

  • Training for providers: Clinicians must be trained in and have access to trauma-informed care, virtual communication, quality digital tools and culturally sensitive care.
  • Clinical protocols: Establish clinical practice workflows for documenting appointments, results of virtual screening and assessment, remote prescribing (e.g., OAT), follow-up plans, and crisis response.
  • Hybrid care plans: Be prepared to integrate in-person assessments as needed, such as clinical assessments, physical examinations, and laboratory assessments.

Support Services

  • Peer support and navigation: Establish access to virtual peer mentors or case managers to optimize opportunities for virtual care and enhance patient engagement.
  • Mental health integration: Ensure timely access to virtual or in-person counseling or psychiatric support for co-occurring conditions.
  • Interpreter services: Offer multilingual support to ensure cultural and linguistic accessibility.

System and Policy Supports

  • Reimbursement: Confirm that virtual services are billable under your local health authority or insurance system.
  • Documentation systems: Use integrated electronic medical records (EMRs) that capture virtual care notes, prescriptions, and follow-up plans, and allow timely communication to the multidisciplinary team for referral, consultation, and ongoing care.
  • Access equity: Address digital barriers by helping patients access devices, data plans, or telehealth-equipped community hubs.

Screening for Substance Use Disorders During Pregnancy via Virtual Care

Early screening for substance use disorders (SUDs) during pregnancy is essential for timely intervention and improved health of the pregnant patient and the fetus(es). Virtual care expands access to screening by overcoming barriers such as stigma, distance, and deficiencies in provider numbers—particularly in rural or underserved areas. Telemedicine platforms can seamlessly integrate validated tools like ASSIST, AUDIT-C, AUDIT -10, Drug Abuse Screening Test (DAST-20) | CAMH, TWEAK, T-ACE and 4Ps Plus © into virtual appointments or patient portals, encouraging more open disclosure in private, comfortable settings.

Virtual screening is especially effective where confidentiality is a concern and can be incorporated into early prenatal intake by trained members of the multidisciplinary team. While limitations exist—such as a reduced ability to assess physical signs and the reliance on patient self-report—hybrid care models combining virtual and in-person assessments can enhance accuracy of diagnosis and response to treatment. With trauma-informed communication, cultural sensitivity, and strong digital infrastructure, virtual screening can significantly improve timely access to care and early identification of at-risk individuals.

Diagnosis of Substance Use Disorders in Pregnancy via Telemedicine

Diagnosing substance use disorders (SUDs) during pregnancy requires clinical sensitivity, trauma-informed care, and an understanding of each patient's social and clinical context. Telemedicine offers a practical and effective way to conduct structured diagnostic assessments using standardized tools—especially in rural, remote, or underserved communities where access to specialized services is limited.

Virtual platforms allow skilled clinicians to perform consistent, evidence-based evaluations based on DSM-5 criteria through secure video conferencing. These assessments can also include psychosocial and mental health factors and support collaboration across multidisciplinary teams.

While telemedicine improves access and reduces delays to care, it may limit the ability to observe physical signs of substance use. For this reason, hybrid models that combine virtual assessments for SUD with periodic in-person evaluations are recommended to enhance diagnostic accuracy and safety.

To ensure equitable care, virtual diagnosis should be culturally adapted, offered in the patient’s preferred language, and supported by training that addresses implicit bias and social determinants of health. When implemented thoughtfully, telemedicine enables timely, inclusive, and patient-centered diagnosis for pregnant individuals experiencing substance use.

Treatment and Management of Substance Use Disorders During Pregnancy via Telemedicine

Effective treatment of substance use disorders (SUDs) during pregnancy requires a comprehensive, multidisciplinary approach that addresses the health of both the pregnant patient and the fetus(es). Telemedicine has emerged as a valuable tool in delivering this care, improving access, privacy, and continuity for patients who face barriers to in-person services. Virtual platforms can support the full spectrum of care—including medication-assisted treatment, behavioral therapy, harm reduction, and mental health support.

Opioid agonist therapy (OAT)—such as methadone or buprenorphine—is a cornerstone of treatment for opioid use disorder in pregnancy. Telemedicine enables initiation, monitoring, and maintenance of OAT, especially for patients in remote areas. Eligible individuals may receive virtual check-ins and extended take-home dosing, supported by tools like e-prescriptions and pill count apps to optimize safety and adherence.

Behavioral interventions like cognitive behavioural therapy (CBT), motivational interviewing, and group therapy can be effectively delivered via video or phone, helping to manage co-occurring mental health concerns, such as anxiety or depression. Peer support networks and mentorship programs offered virtually may also provide emotional reinforcement and help sustain long-term recovery.

Care should always be tailored to individual needs based on clinical risk, stage of pregnancy, and social circumstances. High-risk patients may require in-person care exclusively, hybrid care combining virtual and in-person visits, or more frequent virtual care follow-up. While challenges like access to technology and digital literacy exist, these can be addressed through provider training, infrastructure support, and opportunities for flexible care delivery.

Importantly, virtual care may complement, but does not replace, routine prenatal assessments. When integrated into a broader perinatal care plan, telemedicine enables safe, equitable, and consistent treatment for individuals navigating substance use during pregnancy.

Please refer to the SOGC’s guideline on Identification and Treatment of Perinatal Mood and Anxiety Disorders for information about perinatal mental health.

Postpartum Support and Follow-Up via Telemedicine

The postpartum period is a crucial time for individuals in recovery from substance use disorders (SUDs), marked by increased vulnerability to relapse, mental health challenges, and disengagement from care. Telemedicine offers a flexible, effective way to maintain consistent follow-up, monitor well-being, and support ongoing recovery during this transitional phase—particularly for patients who face barriers to in-person visits.

Virtual postpartum care allows providers to conduct regular video or phone check-ins, support medication adherence (e.g., opioid agonist therapy), and address parenting stressors such as parent sleep disruption and infant feeding patterns. Telehealth platforms also enable periodic mental health screening, including tools like the Edinburgh Postnatal Depression Scale (EPDS), helping to identify and facilitate referral for individuals in need of additional support.

By reducing the need for transportation, childcare, or time away from the newborn, virtual care promotes accessibility and continuity—especially for those in rural or underserved areas. It also facilitates real-time coordination among care teams, including obstetricians, mental health providers, addiction specialists, and peer mentors.

Peer support is a key pillar of virtual postpartum care. Programs led by individuals with lived experience foster community relationships, reduce isolation, and provide practical parenting and recovery guidance. For patients experiencing intimate partner violence or unstable housing, secure virtual platforms can offer discreet, life-saving access to services.

Healthcare teams should also ensure continuity of opioid agonist therapy (OAT) during hospital stays by coordinating virtually with addiction care providers, to avoid gaps in medication and continuing care access.

Overall, telemedicine extends the continuum of substance use care beyond obstetrical delivery, helping to sustain recovery, support mental health during pregnancy and postpartum, and improve outcomes for both parent and child.

Team-Based and Peer-Support Models

A multidisciplinary team approach is essential for providing comprehensive care to pregnant and postpartum individuals with SUDs. This model integrates perinatal care providers, addiction specialists, mental health professionals, social workers, and peer mentors, ensuring that patients receive holistic, accessible, and patient-centered support. Team-based and peer support models have emerged as effective strategies in addressing SUDs during pregnancy and postpartum, particularly when delivered through virtual care platforms. These approaches leverage both professional expertise and lived experiences to enhance patient engagement, build trust, and equip program participants with valuable skills that support long-term recovery and healthy parenting and serve as a gateway to the hybrid care model.

Peer support specialists play a crucial role in providing emotional and practical assistance, helping to reduce stigma, social isolation, and encourage treatment adherence. Research links team-based and peer-support models with higher treatment retention rates, decreased substance use, and improved neonatal health outcomes. Additionally, virtual care and peer support networks create a private, judgment-free environment, increasing the likelihood of honest disclosure and engagement in care. Many peer programs also incorporate culturally sensitive and harm-reduction practices, improving access to and retention of care for diverse populations. By integrating multidisciplinary collaboration and peer mentorship into virtual care models, healthcare providers can offer inclusive, supportive, and effective treatment pathways for pregnant and postpartum individuals managing SUDs.

It is important to recognize that recovery is a very personal journey with multiple pathways. While abstinence may be a goal for some, others may continue to engage in substance use while prioritizing harm reduction. Recovery is not a one-size-fits-all process but rather an individualized experience. Across Canada and the United States, many organizations advocate for a recovery-oriented system of care—one that encompasses a full continuum of care, from prevention to post-treatment, recognizing that treatment itself is just one part of the broader recovery journey.

Challenges and Barriers in Virtual Care

Barriers to Virtual Care for Substance Use in Pregnancy

Access to Technology

Many patients lack reliable internet, smartphones, or private spaces for virtual visits.

Digital Literacy

Providers and patients may struggle to navigate mobile apps, video platforms, or secure portals.

Privacy Concerns

Participation may be limited due to intimate partner violence, stigma, or other safety fears.

Structural Barriers

Fragmented care systems, provider bias, and limited reimbursement for virtual services

While virtual care offers considerable promise in expanding access to substance use treatment during pregnancy, several barriers must be addressed to ensure it is equitable and effective. One major challenge is access to technology. Many patients—especially those in low-income, rural, or unstable living situations—may lack reliable internet, smartphones, or private spaces for virtual visits. Without targeted solutions like device loans, subsidized data plans, or telehealth-equipped community spaces, these individuals risk being left behind.

Digital literacy is another concern. Providers and patients may struggle to navigate mobile apps, video platforms, or secure portals—especially if they have never used these tools before. Privacy concerns, particularly among those patients experiencing intimate partner violence or stigma, can also limit participation in virtual care opportunities. Providers must be trained in trauma-informed, culturally sensitive, virtual communication to create safe and welcoming environments.

On a systemic level, structural barriers—including fragmented care systems, provider bias, and lack of or reduced reimbursement for virtual services compared to in-person care can limit implementation and impact. These challenges disproportionately affect marginalized populations and contribute further to health disparities.

To close these gaps, healthcare systems must invest in technology and human resources infrastructure, provider education, peer support, and policy reform. By proactively addressing barriers, virtual care can become not only more available, but truly accessible, inclusive, and supportive across the perinatal care continuum.

Resources for Health Care Providers

Websites about Virtual Care:

The College of Family Physicians of Canada (CFPC) – Virtual Care

  • Offers guidelines and tools for family physicians looking to adopt telemedicine in their practice, including guidelines on remote care and virtual consultations
    CFPC

The Royal College of Physicians and Surgeons of Canada – Virtual Care

Health Canada

Virtual Care

  • Canadian platform dedicated to providing virtual care solutions, including remote consultations and telemedicine tools for healthcare providers
    Website

Tools:

CFPC Telehealth Toolkit

SBIRT (Screening, Brief Intervention, and Referral to Treatment) – CAMH

  1. A structured, telemedicine-friendly approach for substance use screening and referral.
  1. Health Equity Impact Assessment (HEIA)

AUDIT-C, AUDIT -10 validated screening questionnaire for all patients who use drink alcohol.

TWEAK and T-ACE Screening for Alcohol Use in Pregnancy

  • Validated tools for virtual screening of alcohol consumption in pregnancy, recommended for Canadian providers
  • A validated virtual screening tool for substance use severity

DSM-5 Criteria for SUD Diagnosis – CPA (Canadian Psychiatric Association)

  • Digital and telehealth-adapted diagnostic criteria for perinatal SUD

Edinburgh Postnatal Depression Scale

ASSIST (WHO)

4Ps Plus

Multimedia:

YouTube video found on the BC Women’s Hospital + Health Centre website regarding the conquering of stigma about perinatal substance use.

Tools and Resources for Patients

Resources for African, Caribbean, and Black Patients:

Coming soon

Resources for Indigenous Patients

The Society of Obstetricians and Gynaecologists of Canada (SOGC)