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Since the rise of the pandemic and co-occurring spike in opioid overdoses, medication-assisted treatment (MAT), the standard of care for opioid use disorder, has been successfully delivered via telehealth. One large opioid outpatient treatment center, CODAC Behavioral Healthcare, in Rhode Island, began using telephone counseling with MAT early into the pandemic. CODAC, in conjunction with Brown University, has been studying the effectiveness of telephone counseling with MAT.
Telephonic Telehealth Opioid Treatment Satisfaction
At CODAC, MAT includes the use of medications such as methadone and buprenorphine with counseling. Though the data has not yet been published, the findings are very encouraging. Per Linda Hurley, president and CEO of CODAC, 247 patients and 41 counselors participated in a survey from August through October 2020. Some of the findings for telehealth opioid treatment include:
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- Satisfaction with telephone counseling was 92.3%
- 70.9% reported that telephone counseling was as effective as in-person treatment
- 16% of participants stated telephonic service was more helpful than in-person treatment
- 61.9% said that telephone counseling was as effective with recovery as in-person treatment.
- 19.3% stated telephonic services helped more with recovery than in-person treatment
Ms. Hurley also reported that telephone counseling appeared to be more effective in helping clients achieve their treatment goals.
The Cons of Telephonic Telehealth Opioid Treatment
The majority of clients and counselors found telephonic counseling to be a very positive experience and want to continue it post-pandemic. Some clients, however, indicated that privacy issues existed due to having sessions from home. Some reported a sense that sessions felt impersonal. Counselors also reported that telephonic counseling negatively impacted their workflow.
Why Continuing Data Collection is Needed
Ms. Hurley highlighted the importance of continuing to gather data on virtual care for clients with opioid use disorder because they often have comorbidities that interfere with their access to care, which is exacerbated during a crisis. Further data collection could have real impact on reimbursement for telephone and other forms of virtual counseling. For more information on reimbursement for telephone counseling click here.
Take-Home Medication Dosing Successful
In addition to studying the effectiveness of telephone counseling and MAT, CODAC and brown University have also been studying the impact of distribution of take-home doses of MAT medications to existing clients. Clients studied were receiving either 2 week or 28-day supplies of methadone or other MAT medications and were monitored/counseled either daily or weekly. Out of 160,000 bottles distributed only 1% of the medication was mishandled.
Assessing Client Appropriateness for Telephone Telehealth Opioid Treatment, MAT and Take Home Medication
The use of telehealth opioid treatment with MAT and take-home medications has greatly helped to limit client exposure to COVID-19. Not all clients, however, are appropriate for virtual counseling and medication management. New clients are assessed in person and medication distributed daily.
Per Allegra Schorr, president of the Coalition of Medication-Assisted Treatment Providers and Advocates of New York State, while established patients taking methadone may be able to stay stable, “its the harder to treat and less stable cases that should be looked at carefully.” A balance must be reached between two safety issues: potential exposure to COVID -19 versus the potential for abuse in the less stable client. Click here for more information on assessment/screening for telehealth appropriateness.
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My name is Rick Chavez, M.D. and I am the Chief Medical Officer at Urgent Point Health, PC, and we provide physicians and Nurse Practitioners for initial evaluation, detox treatment, and ongoing behavioral health and maintenance MAT treatment while addicts are treated in IOPs, OPs, and Sober Living. Telehealth has been extremely valuable in treating addiction during Covid, however, I have observed that at discharge too many patients cannot find providers in their communities for maintenance treatment using MAT both locally and when they return to their home state. As a result, the relapse rate is not well managed or controlled. Providers in California cannot continue MAT across state lines and, unfortunately, when opioid addicts return home or to another out of state community, if the individual patient does not continue MAT treatment, there is a > 80% risk of relapse. In addition, many individuals who are unemployed, and have limited resources have discovered that readmission for addiction treatment and transfer to sober living is, unfortunately, a reason to relapse multiple times to obtain care and housing. Some individuals have been admitted and treated 5, 10, and even 20 times and when I see this, it is extremely frustrating. Our system of addiction treatment in the United States has to be changed so that individuals who are treated aggressively, no matter where they reside, will be followed and managed for at least 1 to 5 years. Opioid addiction is literally out of control in our nation with > 100,000 overdose victims last year. MAT using Buprenorphine, Suboxone, and Sublocade is often not being utilized appropriately because too many providers do not understand that the MAT dose must be maintained at 12 to 24 mg of BUPRENORPHINE daily to suppress enough Mu receptors for long enough to prevent relapse. Too many opioid addicts are not prescribed MAT appropriately as a maintenance medications because some programs use buprenorphine for acute detox when it is only released for longterm MAT treatment over 1-5 years because addiction is a chronic illness, like diabetes, and it must be managed as a longterm illness long enough for the individual to change psychologically and emotionally. Our current approach has been a failure and that is why Both patients and providers have to be educated to emphasize to patients that MAT treatment will be a longterm treatment, not one in which treatment will be over in 3 months of rehab. Telehealth is a great way to reach out, but treatment, whether it is in person or via telehealth, must maintain required regular visits with patients, monitor PDMP, ordering of URINE drug screens, providing education, encouraging family interaction, and participation with AA and NA groups, along with maintaining connections with their primary care providers. Addiction is a primary chronic disorder that must be managed like we treat diabetes, hypertension, cardiovascular disease, etc.
I’m a Family Practice Physician who decided to get into addiction medicine secondary to several issues. I was the Medical Director at CRMHS in Vancouver, WA for over 2 years. Throughout my time there, my focus was to get counseling and Psychiatric help for those that needed it. Unfortunately, they were having financial issues, hired the wrong people with no medical experience (although made medical decisions without discussing it with myself or another medical professional) and took a step backwards, saying they were using the “Harm-Reduction” model as studies showed that even if they continue to inject heroin, methamphetamines, cocaine, and take benzo’s, barbs, alcohol, etc., they still did better when associated with a methadone clinic. While this may be true in areas where there is only one clinic (where these studies were done), it does not reflect the area I live and work in, as there are other clinics available. Addiction is one of the most difficult and complex diseases to treat as every facet of their lives may need some form of intervention in addition to MAT. Also, few physicians have any concept of what these patients go through. Blindly prescribing methadone or buprenorphine with little or no counseling, support group, Psychiatric evaluation, etc. is not appropriate! Telehealth is a great way to reach out and make sure your patients are doing well, need adjustments to their medications, getting all the help they need, etc.
Thank you for your comment, Mark.