Reading the tea leaves, so to speak, is the job of our senior team at OPEN MINDS. But I will admit to getting “mixed signals” (or is that mixed tea leaves) when it comes to addiction treatment in the post-crisis recovery. What do we know?
First, the demand for addiction treatment will likely spike. Social distancing is a risk factor for relapse because consumers self-medicate with drugs and alcohol to ease the stress (see Once The Coronavirus Pandemic Subsides, The Opioid Epidemic Will Rage). A lack of face-to-face services, methadone clinic shutdowns, and increases in poverty raise the mortality due to opioids, while opioid-induced diminished lung capacity raises the mortality of COVID-19 (see The Opioid Epidemic Meets The Coronavirus Pandemic—With Potentially Deadly Results). Excessive alcohol misuse is also expected to increase (see Alcohol Use & Misuse During The COVID-19 Pandemic: A Potential Public Health Crisis? and Why COVID-19 Can Be ‘Toxic’ For People In Alcohol Recovery).
Second, virtual services are likely to stay. In March alone, telehealth visits surged 50% due to the pandemic emergency (see Telehealth—Be Careful What You Wish For…)—including virtual addiction treatment services. The question is, what proportion of those visits will remain virtual post-pandemic crisis and what proportion will be face-to-face, in what settings? Historically, the American Society of Addiction Medicine (ASAM) guidelines have been used to answer that question. But recent guidance from the Substance Abuse and Mental Health Services Administration may change those assumptions. The guidance—Considerations For The Care & Treatment Of Mental & Substance Use Disorders In The COVID-19 Epidemic: March 20, 2020—stated “For those with substance use disorders, inpatient/residential treatment has not been shown to be superior to intensive outpatient treatment. Therefore, in these extraordinary times of risk of viral infection, it is recommended that intensive outpatient treatment services be utilized whenever possible.”
Primary care programs are not likely to be the locus of addiction treatment, despite some projections to the contrary. I was surprised at the findings of a recent study (see Medication For Opioid Use Disorder: A National Survey Of Primary Care Physicians)—only 20% of primary care physicians reported an interest in treating opioid use disorders (OUDs) and had limited interest in policy proposals allowing office-based physicians to prescribe methadone or for eliminating the buprenorphine waiver. A small number of primary care physicians reported prescribing buprenorphine (7.6%) or naltrexone (4.0%).
And physician attitudes about medication assisted treatment were also surprising. Two thirds of physicians believe that treatment is more effective with medication than without (67.1%) and that consumers can safely use those medications (63.7%). These physicians were more likely to perceive buprenorphine (77.5%) as more effective than methadone (62.1%) or injectable, extended-release naltrexone (51.4%).
But if not primary care programs, what is the future of specialty addiction treatment organizations? A recent survey of North Carolina addiction treatment programs raises some important financial issues. Of the responding organizations, 57% have had to close at least one program, and 27% have laid off staff. And, 43% report that their financial condition is such that they will need to close by the end of May or early June (see Addiction Professionals Of North Carolina Reports Current Impact On NC Addiction Services & Requests Immediate Emergency Relief Due To COVID-19 Impact).
The next 90 days will be pivotal in what happens with the structure of addiction treatment services and our team will stay on top of the developments that matter. For more on our coverage of addiction treatment financing and delivery, check out these resources in The OPEN MINDS Industry Library:
- Access To Medication Assisted Treatment For Opioid Addiction
- New Study Offers Promising Results Of The Patient Notification Act In The Fight Against The Opioid Epidemic
- Northern Light Acadia Hospital Joins Hazelden Betty Ford ‘Patient Care Network’
- Medicaid Expansion Associated With 9.7% Drop In Opioid-Related Hospitalization
- DEA Proposes Allowing Federally Certified Opioid Treatment Programs To Operate Mobile Units Without A Separate Registration
- Joint Commission Releases New Enhanced Addiction Standards For Behavioral Health
- NQF Releases Final Technical Report On Behavioral Health & Addiction
- Few Residential Opioid Addiction Treatment Programs Provide Access To MAT
- Texas HHS Expands Pilot Program To Provide Resources For Opioid Overdose Survivors
- Highmark Health Seeks To Fight Opioid Stigma & Promote Workplace Recovery Through Partnership With Shatterproof
For even more on developing and adopting innovative treatments, join my colleague and OPEN MINDS Senior Associate, Paul M. Duck, on August 25 in Newport Beach, California for The OPEN MINDS Care Innovation Summit: Solving The Problem Of Access For Consumers With Complex Care Needs.