One effect of the sweeping regulatory changes during the Covid-19 pandemic is that more healthcare providers were able to provide telehealth treatment for substance use disorders. Now, stakeholders are watching closely to see if those changes will continue after the public health emergency ends.
As patients grappled with substance use during the pandemic, many clinics offering treatment programs closed. A survey by the Kaiser Family Foundation last July found that 12% of adults said they had increased alcohol consumption or substance use. More recently, the Centers for Disease Control and Prevention estimated more than 92,700 people died of drug overdoses during the 12 months ending in November 2020, the highest amount ever since it started counting six years ago.
Treatment for opioid use disorder can involve counseling and medication-assisted treatment, such as the use of buprenorphine, methadone or naltrexone to suppress cravings and withdrawal effects. These substances are regulated by the Drug Enforcement Administration, and before the pandemic, could not be prescribed over telehealth without an in-person consultation, leaving some patients to drive long distances for care.
Since then, more clinics have been taking a hybrid approach, combining both in-person and virtual services. For example, a physician might perform an initial assessment and prescribe medication through telehealth, with local clinicians providing in-person counseling and follow-up.
A host of new companies are also making a bet that this model will stay. For example, Bicycle Health, a startup that provides medication-assisted treatment through telehealth, is betting that the regulatory changes will continue after raising $27 million in funding to grow its business. The company gives patients access to Suboxone, tele-therapy and support groups either covered by insurance or for a monthly subscription fee.
Bicycle Health started accepting patients in 2019, seeing about 100 patients at a single clinic in Redwood City, Calif. But with the regulatory changes during the pandemic, the startup was able to change the model quickly, serving more patients across the state of California.
“We just got overwhelmed with demand,” Bicycle CEO Ankit Gupta said in a phone interview. “That’s where we saw there’s a need, where we can actually raise funding, grow quickly, and see patients not only in one state but actually nationwide.”
Now, the company has seen about 6,000 patients spanning 21 states.
“These things that we’re doing exist but the access gap is quite big. That’s when we decided to start Bicycle Health because the stigma of addiction was a big barrier for patients to get into treatment,” he said. “The physical barriers to accessing treatment make telehealth a great modality.”
In particular, Gupta is watching two pieces of legislation that would affect the ability to continue to provide medication-assisted treatment through telehealth. The first, the Telehealth Response for E-prescribing Addiction Therapy Services Act, was introduced in the House and Senate in March after failing to pass last year. It would allow healthcare providers to prescribe certain controlled substances over telehealth as part of medication-assisted treatment therapy programs, without requiring an in-person exam.
Others are watching the Department of Health and Human Services after it announced in January that it would remove certain X-waiver requirements that would make buprenorphine easier to prescribe.
The Substance Abuse and Mental Health Services Administration, which operates under HHS, and other agencies, “…have a great interest in maintaining those pandemic flexibilities that positively impact patients, treatment rates, access, and satisfaction,” wrote Dr. Robert Baillieu, senior clinical and practice advisor for SAMHSA’s Center for Substance Abuse Treatment. “The evidence tells us that telehealth is effective across the continuum of care for serious mental illness and substance use disorders, including screening and assessment, treatment, medication management, behavioral therapies, case management, recovery supports, and crisis services. Accordingly, the Department of Health and Human Services continues to assess telehealth and the legal mechanisms that might allow it to continue in a safe and equitable manner.”
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