One effect of the comprehensive regulatory changes during the Covid-19 pandemic is that more healthcare providers are able to provide telemedicine treatments for substance use disorders. Now, stakeholders are paying close attention to see if these changes will continue after the public health emergency is over.
As patients struggled to cope with drug abuse during the pandemic, many clinics that provided treatment plans were closed. A survey conducted by the Caesars Family Foundation in July last year found that 12% of adults say they have increased Drinking alcohol or substance use. Recently, the Centers for Disease Control and Prevention estimated that in the 12 months ending November 2020, more than 92,700 people died from overdose. The highest amount since the calculation started six years ago.
The treatment of opioid use disorder may involve counseling and drug adjuvant therapy, such as the use of buprenorphine, methadone, or naltrexone to suppress craving and withdrawal effects. These substances are supervised by the Drug Enforcement Administration. Before the pandemic, without personal consultation, it was impossible to prescribe via telemedicine, causing some patients to travel long distances to receive treatment.
Since then, more and more clinics have adopted a hybrid approach, combining face-to-face services with virtual services. For example, doctors may conduct preliminary assessments and prescribe medications through telemedicine, and local clinicians will provide face-to-face consultation and follow-up.
Many new companies are also betting that this model will continue to exist. For example, Bicycle Health, a startup that provides drug-assisted treatment through telemedicine, is betting that after raising $27 million in funding to grow its business, regulatory changes will continue. The company allows patients to use Suboxone, remote treatment and support groups with insurance or monthly subscription fees.
Bicycle Health began accepting patients in 2019, receiving approximately 100 patients at a clinic in Redwood City, California. But with regulatory changes during the pandemic, the startup was able to quickly change its model to serve more patients in California.
“We were just overwhelmed by demand,” Bike CEO Ankit Gupta said in a telephone interview. “This is where we see a need. We can really raise funds, grow rapidly, and see patients not only in one state but in fact across the country.”
Now, the company has received approximately 6,000 patients from 21 states.
“These things we are doing exist, but the visit gap is very large. At that time we decided to start Bicycle Health because the stigma of addiction is a major obstacle for patients to receive treatment,” he said. “The physical barriers to treatment make telemedicine a great way.”
In particular, Gupta is paying attention to two pieces of legislation that will affect the ability to continue to provide drug-assisted treatment through telemedicine. First, Telemedicine response to the Electronic Prescription Addiction Treatment Service Act, After failing to pass last year, it was proposed in the House of Representatives and the Senate in March. It will allow healthcare providers to prescribe certain controlled substances through telemedicine as part of a drug-assisted treatment plan without the need for in-person inspections.
Others are concerned that after the Department of Health and Human Services announced in January that it would remove certain X exemptions, the requirement would make buprenorphine Easier to prescribe.
The Substance Abuse and Mental Health Services Administration, which operates under HHS and other agencies, “…is very interested in maintaining the flexibility of epidemics that have a positive impact on patients, treatment rates, accessibility, and satisfaction,” Senior Robert Bay Dr. Leah wrote. Clinical and practical consultant of SAMHSA Substance Abuse Treatment Center. “Evidence tells us that telemedicine is effective in continuous care for severe mental illness and substance use disorders, including screening and assessment, treatment, medication management, behavioral therapy, case management, rehabilitation support, and crisis services. Therefore, health and The Department of Public Services will continue to evaluate telemedicine and the legal mechanisms that may enable it to proceed in a safe and fair manner.”
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