Q&A: The Role of Telehealth in Fighting the Opioid Epidemic
Amid the COVID-19 pandemic, drug overdose deaths in the United States have increased. The CDC estimates that more than 107,000 people died in 2021, an increase of nearly 15% from the more than 93,000 deaths in 2020.
But the pandemic has also caused a surge in the use of telemedicine. Regulations surrounding telemedicine prescriptions for controlled substances were relaxed during the health emergency, allowing providers and startups to offer drug treatments such as buprenorphine for opioid use disorder.
One of those companies, Bicycle Health, offers virtual assistance and drug prescriptions. Founder and CEO Ankit Gupta and Chief Medical Officer Dr. Brian Clear sat down with ComoHow to discuss the therapeutic landscape for patients battling opioid use disorder and the recent $50 million raise in the startup’s Series B.
ComoHow: Why do you think telemedicine works well for this population?
Dr. Brian Clear: It’s about access. Therefore, we know that only one in 10 patients with a substance use disorder received treatment in the last year. There are many reasons for this, mainly geographic access. Forty percent of counties in the US don’t even have a registered provider to give you buprenorphine for opioid use disorder.
There is also the stigma. Especially in cities where people in their health system or their neighbors know who they are, patients are reluctant to go to these programs, which are certified programs licensed for specialized addiction care, and these programs are known to offer specialized care for addictions.
In our program, we found that 30% of patients who contact us have never been diagnosed with an opioid use disorder and have never accessed opioid use disorder treatment before, which is truly remarkable. This means that we serve people who would not otherwise have access to any other level of support. We are finally breaking that cycle of always serving the same small subpopulation of patients.
Ankit Gupta: Yes, and I’ll give you an example. There is a new regulation in Alabama that recently went into effect that requires an in-person exam within the last 12 months to prescribe a controlled substance. For the past nearly two months, we have had an entire task force working tirelessly to help our hundreds of patients find local providers in Alabama.
After all this effort, we found that less than 20% of patients found a local provider. It is because the providers were not available. They were not affordable. There was a lot of stigma as Brian mentioned. We have received reports that patients do not want to be seen entering clinics; they don’t want their car parked outside. So, we were in serious trouble.
We literally had to take a couple of providers to Alabama and spend a week there just to comply with the regulation and still be able to see the patients that we have. We are not enrolling new patients, but we will continue to care for the patients we have, until we find a suitable option for them in the field. And therefore there is a massive, massive lack of access.
MHN: There has been an increase in overdose deaths in recent years. What have you heard from patients about their experiences accessing care?
Of course: it has always been sad and access has not deteriorated in the last two years. What has happened is that fentanyl is now almost universally present in the illicit drug supply. Therefore, patients who use illicit opioids are much more likely than ever to overdose.
COVID has kept people in their homes for a long time and has made people even more reluctant to access resources that were already very limited. Now, I think we’re starting to get over it and people are going back to a more normal life. So I can’t say that COVID restrictions are keeping people out of care.
But now we’re at a place where it’s not just about fentanyl; are new, even more potent, fentanyl analogs found in the illicit drug supply.
Gupta: We sent out a survey to patients about four or five months ago. There were about 1,000 patients and we asked them a lot of questions, one of which was about their views on recovery and addiction treatment during COVID.
And what we learned was quite different from the fiction out there. We learned that 77% of our patients said that the pandemic did not hinder maintenance or recovery. In fact, 42% said it made things easier. So once again it shows how telemedicine can really improve access.
MHN: Bicycle Health recently raised a $50 million Series B. How do you plan to use that investment?
Gupta: So far we’ve been pretty successful in reaching patients; so far we have served over 17,000 patients in 26 states. But we are still starting.
We will use this investment to continue to increase access to treatment for opioid use disorder. This includes contracting with healthcare providers so we can increase the ability to see patients, developing our technology to help us deliver care, and increasing the quality of care through data analytics and patient engagement tools we create internally to through our random home drug testing program. .
We have also had some success in collaborating with health plans. We are seeing strong demand, both from commercial and Medicaid-managed plans, to increase access and reduce cost for this patient population. Therefore, we are investing to increase these associations.
We have now started to get incoming interest from providers who want to work with us, refer patients to us, or co-manage patients. We also want to use the investment to increase our partnerships with health care providers, case managers, discharge planners, particularly in corrective health, but also with employers to reach patients.
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