The greatest health crisis of our generation is going to require that we use every innovative tool in our arsenal.
Back in 2011, South Florida was the epicenter of a prescription drug epidemic. There were pain clinics on every corner, one stop shops for on-demand pills of poison. Being a South Floridian, I witnessed this first hand. Ever heard of the Oxy Express? This was the nickname of the stretch of I-75 that during this time was frequented by out-of-state addicts and drug traffickers making their way down to South Florida for their prescription drug supply. Many never made the trip home.
From 2012 to 2013, after a Florida crackdown to shut down these pill mills, those addicted to the shrinking supply of prescription painkillers searched for alternatives. Since then, the use of heroin, fentanyl and deadlier synthetic offshoots has exploded in South Florida, and the ripple effects are now being felt across the county. Drug overdose deaths in 2016 exceeded 59,000, the largest annual jump ever recorded in the United States, according to preliminary data compiled by The New York Times. More Americans died of drug overdoses in 2016 than died in the entirety of the Vietnam War.
The question that I ask myself as I watch yet another dubious recovery center crop up in a nearby strip mall: “How can we leverage digital health tools to counteract the rising need for addiction treatment? Here are three specific ways, though its only the tip of the iceberg.
Increase Telemedicine Use for Medication-Assisted Treatment Programs
Treating opioid addiction via MAT is probably the most prevalent and impactful way to break down these chemical dependencies. Medication-assisted treatment (MAT), including opioid treatment programs (OTPs), combine behavioral therapy and medications to treat substance use disorders. The problem is, especially in rural areas, the demand for this type of treatment far exceeds provider capacity. For people with Opioid Use Disorder who are receiving medication treatment with buprenorphine, a telepsychiatry approach—using video conferencing as an alternative to in-person group sessions—provides similar clinical outcomes, reports a study in the Journal of Addiction Medicine.
A key aspect of the opioid epidemic is the lack of these types of treatment options for millions of Americans living in these rural communities where opioid addiction has been most prevalent. Current thinking is that there needs to be a mechanism in place to expand access to these services via primary care practices—the places where most rural Americans receive care. Last year The Agency for Healthcare Research and Quality released a series of grants that awarded $12 million in funding over the next three years. The initiative brings together innovative teams of state health departments, academic health centers, researchers, local community organizations, physicians, nurses, and patients.
Together they’re charged with delivering MAT to hundreds of rural practices in places such as Muskogee County, Oklahoma, where there were more than 10 opioid-related deaths per 100,000 people per year over the past few years, where over 1300 people are thought to be in need of treatment for opioid addiction, and there are currently no primary care physicians providing MAT. And Bent, Colorado, where the overdose death rate has increased from fewer than 10 to over 20 per 100,000 since 2002. The practices involved in the initiative are working towards providing access to MAT to over 20,000 individuals struggling with opioid addiction using innovative technology, including patient-controlled smart phone apps, and remote training with expert consultation using Project ECHO.
Project ECHO is a tele-health program started with AHRQ support that links specialists at an academic hub to primary care providers working on the front lines in rural communities. Together with their grantees, AHRQ will build a blueprint for how other communities and primary care teams can overcome the barriers of providing MAT, and ensure access to care across America’s rural communities. Telemedicine will continue to emerge as an essential avenue for administering these critical MAT services to patients.
Alumni Programs via mHealth
One of the biggest issues in treatment today is the lack of, or limited ability for centers to provide follow-up care after a resident completes their program. This is an important factor in reducing the depressing statistic that 60 percent of people who go to drug or alcohol rehab relapse after one year and another 80 percent will go to another facility. Much of this can be credited to the lack of follow care from these facilities and now app-based after care solutions are being developed to address this gap in treatment.
The idea is that by maintaining a connection with residents utilizing digital platforms when their programs end, treatment providers can now know how their patient populations are faring in the world. One such app is Sparkite, which a patient downloads at the time they leave a rehab program and receive weekly quality of life surveys to fill out. From a business point of view, treatment providers can influence the likelihood that if the patient does relapse, they’ll return to the their facility rather than going to a new one. The treatment centers get billed on a monthly basis for the app service. A consistent digital touch and following of these patients after they leave is what will be needed to make sure they don’t bounce back.
Substance Abuse Treatment Via Virtual Reality
To help people overcome drug addiction, many research studies are turning to virtual reality. They are building hyper-realistic virtual worlds to recreate situations that trigger cravings for nicotine, alcohol, weed, and now, hard drugs like heroin. Traditional relapse therapy usually involves role playing: Therapists often pretend to be a friend or some other familiar person and offer the patient their drug of choice in order to teach them avoidance strategies. By strapping patients into a virtual reality headset and running them through a familiar scenario where they commonly use the drug, such as at a party, the role playing can be much more realistic and effective. The trick is to make addicts crave virtual drugs. And then choose not to use.
The opioid epidemic may be the most critical medical outbreak of our generation. Now more than ever, there needs to be a deep understanding from providers that this epidemic cannot be cured without incorporating innovative technologies. Solutions like the ones outlined above are pushing the limits and creatively attacking a problem now effecting millions. The need for treatment, education and access will drive the market for these technologies. Whether they can truly make a dent in the rise of the abuse of these substances still remains to be seen.