From the driving force's seat of his parked truck, Lewis remembered what it felt prefer to take opioids.
He says he was prescribed Vicodin after having his wisdom teeth removed at age 15, triggering an addiction he struggled with for nearly twenty years. (Lewis' last name has been omitted resulting from concerns about his medical privacy.)
“I just remember it taking all my worries away,” the Pennsylvania native said during a Zoom interview in September. “It almost made me feel like I didn’t have to be afraid.”
Eventually he began experimenting with stronger opiates, namely Percocet and Oxycontin, and switched to heroin a couple of years later. He said it was “the worst decision” he had ever made.
“I lost everything,” said Lewis, who’s in his early thirties.
He has been recovering since 2021 and credits a virtual telemedicine company, Ophelia, with helping him get back heading in the right direction: “It literally changed my life,” he said.
Ophelia partnered with Highmark Wholecare last March to supply telemedicine addiction services to its patients, including Medicaid and Medicare members based in Pennsylvania; In April, it was named the primary Virtual Center of Excellence for Opioid Use Disorder in Pennsylvania. Centers of Excellence are designated treatment centers officially recognized by the state Department of Human Services.
Ophelia now joins other local centers of excellence offering telehealth services for opioid use disorder, including JADE Wellness Center on the South Side and Gateway Rehabilitation Center in Greentree.
These moves exhibit the increasing popularity of telehealth services because the early days of the COVID-19 pandemic, when capabilities were expanded to enable virtual prescribing of controlled substances.
Many within the larger population select telemedicine for convenience; For individuals with opioid use disorder, the flexibility to buy medications to treat the condition in a discreet and efficient manner has improved retention rates and reduced stigma related to addiction.
However, there’s a risk of this policy being terminated. Since the U.S. public health emergency resulting from the pandemic ended last May, exemptions allowing controlled substance prescribing in lieu of telemedicine were now not guaranteed. This program has now been prolonged twice by the Drug Enforcement Administration and the U.S. Department of Health and Human Services. The current extension runs until December thirty first.
“There is a lot of support at the federal level” for telemedicine, said Wilson Compton, deputy director of the National Institutes on Drug Abuse. “It is unclear whether this can continue.”
Lakshmi Reddy, Chief Medical Officer of Highmark Wholecare, said the nationwide partnership with Ophelia is an incredible option to provide treatment options for patients with substance use disorders and reduce stigma.
“This will be life-saving,” Reddy said. “A significant portion of our members suffer from a substance use disorder and require treatment.”
The advantages of telemedicine include potential barriers to in-person appointments, akin to: B. the necessity to secure transportation and childcare, in addition to scheduling around a job.
Patients often connect during lunch breaks, noted Allison Berneking, Lewis' physician and Ophelia's regional clinical director. Lewis, who lives in Lackawanna County, often answered calls while walking through the countryside, she said.
Many patients, like Lewis, began using the virtual platform just because they’d no other options, Berneking said. Lewis discovered Ophelia in 2021 through a Facebook ad he almost scrolled past. He said he tried every part — rehab, Suboxone clinics, Alcoholics Anonymous — but all the time returned to using.
“At that point I just wanted to stop everything. I needed a different kind of change.”
And when he became a patient, he didn't have a automobile to drive to a clinic.
“If someone takes three buses to get to a doctor's appointment, missing just one bus could mean you miss the appointment and that could lead to a relapse,” Reddy said. “We want our members with substance use disorders to feel like they have options.”
NIDA's Compton noted that transportation will be cumbersome even inside city limits — and with a condition like opioid use disorder, the need for treatment can vary widely based on mood, environment or access to substances.
Jody Glance, medical director of addiction services at UPMC Western Behavioral Health, also runs telehealth services for individuals with substance use disorders and has seen the advantages of this approach.
“Some people we treat struggle with debilitating chronic pain and find it difficult to come to the clinic,” she said. “This is the group that I think will be helped the most (by telemedicine).”
Telemedicine allows the system to capture patients and start treatment sooner, somewhat than having to place them on a month-long waiting list or refer them to a specialist, which creates additional hurdles. Berneking takes care of patients while they fold laundry, take care of their children or use the WiFi in the general public library.
Such an intimate look right into a patient's life can strengthen the doctor-patient relationship. Berneking noted that sometimes general contractor patients would excitedly show her the structure they were constructing or that she would meet children on the screen.
“People open up and become more vulnerable when they feel safe,” she said.
Glance echoed that sentiment. Sometimes she inquires about artwork hanging on the partitions behind her patient, akin to someone with a passion for photography.
“We were able to talk to patients about things that might not otherwise have been brought up if the visit had not taken place at home,” she said. “You learn more about their personal lives, beyond what they might bring to the doctor’s office.”
Both Glance and Berneking said they’ve found no-show rates have decreased, retention rates have increased and patients are more engaged through telemedicine visits, which is supported by research. This could mean the difference between someone who relapses and doesn't seek treatment and someone who’s prescribed Suboxone – like Lewis – and gets sober.
“Being able to take my calls or meetings over Zoom has been great,” Lewis said. “This is huge for people – the ability to be in the comfort of their own home or not have to cancel work to go to a doctor’s appointment. That kind of held me back. I didn’t want to have to take a break from work.”
However, telemedicine also has disadvantages, especially as an emerging technology that only became widespread resulting from the pandemic. (Compton called it a “natural experiment.”)
Firstly, patients will need to have access to the web and a tool on which they’ll perform the appointment.
Berneking said this hasn't been a giant problem in her practice – even homeless people often have smartphones and might use the web at friends' houses, the library or the café. Highmark Wholecare is taking steps to enhance broadband access in rural areas and address this issue by working to secure federal funding, Reddy said.
The biggest barrier to successfully prescribing medication for opioid use disorder through telemedicine has actually been stigma, some providers say.
“Not all pharmacies are willing to fill (prescriptions) via telemedicine,” Compton said.
Despite these obstacles, telemedicine providers recognize the profit to their patients—and the danger of foregoing this feature.
More than 200 organizations, including UPMC Health System, signed a letter to DEA Administrator Anne Milgram in April asking institutions to update their proposed rules and encourage pharmacies to proceed this prescribing method beyond Dec. 31.
“Telehealth services enable timely access to care for more patients at a time when there is a shortage of health care providers across the country and great need, particularly in rural and underserved communities,” said Noreen Fredrick, vice chairman of outpatient services Healthcare Community Behavioral Health Services for UPMC Western Psychiatric Hospital, in a press release about why it signed the letter. “Abolishing the current flexible rules would create barriers for many patients and have a significant impact on care delivery and treatment services.”
Telemedicine has normalized addiction treatment amongst other health services, Glance said, helping to combat stigma.
“We all moved into the virtual care space at the same time,” she said. “We could treat a patient for asthma and then treat them for opioid use disorder.”
Still, there are occasions when an in-person visit is warranted and seeing a health care provider only through a screen can prevent necessary comprehensive exams. Blood tests, physical exams or vital signs like blood pressure can inform doctors a couple of patient's condition – a missed opportunity with a virtual visit.
For Lewis, there was a transition from weekly visits to Berneking to monthly. He bought the truck through which he gave the interview in September and now works in construction.
“I really think working with Ophelia gave me those opportunities,” he said. “For other people it's something small, but for me personally it's a big milestone. I often think about it, if I just kept scrolling over this post, I probably wouldn't have a car. I probably wouldn't have a job. Things would be different.”
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