Before the coronavirus, the nation was focused on opioids. An overdose epidemic stole more than 67,000 lives in 2018 alone, and until recently, the U.S. was only beginning to turn the tide. While changes created due to COVID-19 haven’t been easy for anyone, it is hitting one group particularity hard: those battling an opioid addiction.
The challenges of substance use disorder during a viral pandemic cannot be overstated. Addiction, according to pain management expert Dr. Steven Passik “is the result of exposure to an abusable substance in a vulnerable person at a vulnerable time.” It is hard to remember when so many Americans felt as vulnerable as they do right now.
COVID-19 is more than a medical crisis.
With the American death toll nearing 125,000 people, hundreds of thousands are no doubt mourning a loved one lost to the coronavirus and nearly every American fears for their family’s health. But COVID-19 is more than a medical crisis. The pandemic has unleashed extreme uncertainty. Great Depression-level unemployment has ushered in financial hardship. Job loss in the U.S. is frequently accompanied by loss of health insurance, which compounds already heightened anxiety. Marital problems can easily erupt under the pressure, and some individuals are isolated in toxic living situations without realistic alternatives.
These are just a few of the stressors that can precipitate addiction or relapse. Unfortunately, our healthcare system which was exhausted before COVID-19 has only grown worse as a result of even less time with patients and a drastic change in the delivery of care. Compounded with a global pandemic, we’re presented with a “perfect storm” for the estimated three million Americans struggling with opioid use disorder and many more are at risk.
At the beginning, an overwhelmed healthcare system operating under social distancing requirements is struggled to respond. Now, more than three months in, the healthcare system is still facing challenges: patients avoiding the hospital for fear of contraction, canceled elective surgeries, and worries of closures in local hospitals due to depleted financial resources. Addiction recovery has typically centered on in-person and residential treatment programs, often combined with patients’ regular participation in local support groups. But many of these options recently have been restricted or even shuttered.
Moreover, medication-assisted treatment (MAT), which involves monitored access to opioid-replacement therapies, is currently difficult to sustain. Patients in some areas, if unable to travel to a clinic every day, are legally barred from MAT. In other places, provider-observed dosing has been replaced with home dosing regimens, which increases the potential for unsanctioned dose escalations and possible overdose.
Pain management patients are also at increased risk for poor outcomes during this uncertain time.
That’s why doctors monitor chronic opioid therapy patients closely to detect irregularities that could indicate substance misuse. This involves monthly in-person visits, where a face-to-face encounter is vital to detecting red flags. In the absence of in-person doctor visits during COVID-19 and—ever-importantly—the in-between time a patient doesn’t meet with a doctor, technology plays an essential role.
Several companies are using a digital approach to change how patients can treat their addictions with the help of phones, email, and computers. Pack Health, a digital health coaching company, utilizes Health Advisors who deliver personalized support by talking and texting with patients in between doctor’s appointments, helping to prevent health issues from ballooning, and also providing people with the tools necessary to improve their health—and get through tough times.
While COVID-19 will likely be with us for years, we will have to adapt to new ways of health care delivery, including addiction prevention and treatment measures. Our primary goal is to address today’s limitations on physician-patient interactions surrounding opioids. We do so both by maximizing the impact of each appointment and by helping people through the 99.9 percent of time they spend outside the doctor’s office.
A mechanism to confront opioid addiction proactively is necessary for a post-COVID-19 age of care delivery.
To this end, we recognized our joint initiative, the Care Continuity Program (CCP), which was created well-before COVID-19, has now become even more integral in our new world of care delivery. When our companies joined together to create this program last year, it was our hope to find a mechanism to confront opioid addiction proactively and inspire others to contribute their own solutions as well.
The CCP gathers key patient information in advance and provides the doctor with a quantifiable, up-to-date assessment of the individual’s opioid risks and benefits. This helps improve prescription safety and jumpstart important conversations in the office—even the virtual office.
From there, digital health coaching provides the crucial, personal, day-to-day support so often missing from a treatment regimen. Digital health coaches can deliver opioid education for pain management patients or dive into what’s going on in the life of someone in recovery and strategize ways to stay sober. Because digital coaches are seen as confidants by their patients, it gives them an opportunity to have casual conversations, allowing patients to better understand health care information. In fact, many patients find the information easier to absorb, and coaches can help patients circle back with the physician whenever needed.
This may be technology’s greatest potential to remedy the epidemic: increasing access to and lowering the threshold for receiving treatment.
Together, these solutions can fill certain gaps left wide open during the pandemic, but they alone will not be sufficient. More members of the health care community, technology innovators, local institutions, and public officials must step up with ideas, resources, and policy adjustments. The opioid epidemic has largely taken a backseat to the coronavirus pandemic; but together, with our new digital tools, we can continue to build the infrastructure and programming to move forward.
John Bowman is the founder and Chief Executive Officer of Sure Med Compliance, a healthcare software company with a mission to end the opioid epidemic through greater prescribing compliance. Mazi Rasulnia, PhD, MPH is founder and CEO of Pack Health, a leading digital health coaching company based in Birmingham, AL.