By Alison Knopf
Imagine opioid treatment program (OTP) patients being able to get counseling and prescriptions from their own smartphone, while sitting in the comfort of their home. This is now reality for two OTPs operated by California-based Aegis Treatment Centers.
“We’ve been practicing telemedicine for three years in our Fresno and Delano clinics,” said Alex Dodd, Aegis CEO and president. These are all private-pay patients, either through insurance or by self-pay. And the program may expand to other clinics, thanks to funding from the Cures Act, Mr. Dodd told AT Forum.
The software used for telemedicine must be compliant with the Health Insurance Portability and Accountability Act (HIPAA), said Mr. Dodd. You can’t use Skype or Facebook, for example. Many psychotherapists already have such software, he added.
Admission and Buprenorphine Induction
Admitting patients for buprenorphine induction takes longer than admitting them for methadone induction, because more observation time is needed to make sure the patient’s condition is stable, said Mr. Dodd. So the first part of the admission process occurs face-to-face with the physician, who explains to the patient that some degree of withdrawal must occur before induction can begin. The next day, if the patient can’t come to the doctor, or if the doctor isn’t in the clinic, induction can be done by telehealth.
The physician begins the telehealth induction by calling the patient and conducting an interview about any symptoms the patient may be having. Via the screen, the physician can observe the patient for withdrawal symptoms. “This is one of those situations where experience really matters,” said Mr. Dodd. “If you are an experienced doctor who has seen hundreds if not thousands of patients, you can do this.”
Coming Soon: More Counseling by Telehealth
Currently, patients go to OTPs in Fresno or Delano for counseling. As California rolls out its hub-and-spoke Cures money, more counseling will take place by telehealth, said Mr. Dodd, who added, “I’m sure that in the next year or two we’ll be using telehealth for both admissions and counseling.”
The Fresno and Delano sites were chosen because the Aegis doctor most familiar with buprenorphine works with patients at those clinics.
But the most important part of treatment is not induction, said Mr. Dodd. “It’s the communication between the patient and the counselor.” He went on to quote Marc Lasher, MD, medical director of Aegis: “Medication is good, counseling is good, but medication and counseling together is the best.”
Regardless of which medication the patient is taking—methadone or buprenorphine—the patient is in a “stable, non-drug-seeking state,” said Mr. Dodd, “and is open and amenable to a dialogue.”
Bright Heart Health has received some of the Cures money to provide telemedicine to California patients with opioid use disorders, according to Mr. Dodd. “They will use telehealth extensively, doing everything others would do with bricks and mortar. They want to admit patients over telehealth, dispense medication through telehealth, and do counseling through telehealth.”