Push to telehealth means more medication to treat addiction in northern Michigan

May 7, 2020

A Suboxone tablet.
Credit Max Johnston

As coronavirus sweeps through the nation, tearing families apart and overwhelming hospitals, there’s one part of healthcare that’s expanding: opioid addiction treatment.

In northern Michigan, patients have better access to doctors and medication via telehealth. Doctors are getting paid more consistently and seeing a huge decrease in cancellations from patients

In many aspects, medication-assisted treatment (MAT) for opioid addiction is more accessible than ever before.

A window for patients and doctors 

Doctors and patients agree — it was hard to find medication to treat opioid addiction in northern Michigan.

Very few doctors were providing it, creating long waitlists and drives for anyone looking for prescriptions of Suboxone or Zubsolv, medication that can curb opioid cravings and withdrawal symptoms.

"Poorly thought out laws are driving patients at risk to heroin instead of seeking providers because there (are) not enough of us," Addiction Specialist Dr. William Morrone said via email.

Doctors prescribing medication-assisted treatment (MAT) for opioid addiction need a Drug Enforcement Agency waiver and, until recently, had to get prior-authorization from insurance companies to get paid.

On top of the stigma of treating patients suffering from addiction, many just avoided it entirely.

"A lot of doctors and clinics don’t wanna make that a part of their primary care," Dr. David Best of Traverse City said. "Sometimes patients don’t want to engage in that treatment if it’s too difficult, like they have to travel too far, (or) their insurance isn’t taken."

Last year IPR reported that people recovering from Substance Use Disorder (SUD) in northern Michigan had tremendous difficulty finding medication like Suboxone. Pam Lynch, the director of addiction outreach agency Harm Reduction Michigan, estimates there are less than 20 MAT providers in northern Michigan.

For patients, that made in-person visits with doctors extremely difficult or impossible. Multiple patients say they were driving an hour or more just to meet with a doctor that could write them a prescription for medication like Suboxone.

"I really jumped at the opportunity," recovering heroin addict Mike Lober told IPR last year. "I had to do something.”

But that’s changed during the COVID-19 pandemic after the Trump administration loosened federal regulations on virtual healthcare.

"Medicare patients can now visit any doctor by phone or video conference at no additional cost, including with commonly used services like FaceTime and Skype — a historic breakthrough," President Donald Trump told reporters in March.

Because of that change one of the biggest barriers to MAT — distance from a doctor — is gone. Now patients can teleconference with their physicians and doctors know they’ll be reimbursed for those virtual visits.

"Two months ago this was unbillable and maybe illegal," Morrone said.

David Best treats over 200 patients for opioid addiction from his practice in Traverse City. He’s gotten around 20 new patients in the past month since the switch to telehealth. Some were being treated at in-patient facilities that have closed or were driving hours downstate to find medication.

"We’ve had a number from Cadillac, (from) all over the state. From Mancelona we had two new people," Best said.

Best uses Backline, a software for virtual visits that is HIPAA compliant, to talk to his patients. He says it’s no replacement for in-person visits, which he still does depending on the patient, but he is able to do most things he did face-to-face like pill counts.

 

David Best uses a HIPAA-approved video chat software called Backline to talk to his patients.
Credit Max Johnston / Interlochen Public Radio

And being able to keep operating under Gov. Gretchen Whitmer’s “stay at home” order is key.

"We haven’t had to lay off employees, we’re actually looking to expand because of the great need," Best said.

Telehealth may end up incentivizing more doctors to offer MAT to meet the high demand up north, he said.

Harm Reduction Michigan has connected dozens of patients to providers across northern Michigan in the past few weeks. Most of them didn’t have a doctor to write them a prescription or were driving very far to get it.

"I think we’re able to show … that this is actually really beneficial and gonna have some positive outcomes," Pam Lynch said, adding that she hopes telehealth is a permanent change.

Therapy is another key

CEO of Addiction Treatment Services Chris Hindbaugh says they haven’t taken more patients in their MAT clinic, but telehealth has reaped other benefits.

A key part of medication-assisted treatment for SUD is wraparound care like therapy and behavioral health counseling. For a variety of reasons, like transportation or the stigma sorrounding treatment, Hindbaugh says it’s common for patients to miss or skip therapy appointments.

But Hindbaugh says since the switch to telehealth, patients at ATS’ clinic have been showing up.

"Our ‘no-show’ rates have dramatically decreased," Hindbaugh said. "Folks are showing up for their appointments, not only because they’re home, but also it’s easier to access."

One of ATS’ psychiatrists had all of their patients show up for their scheduled (now virtual) therapy appointments. That’s never happened before according to Hindbaugh, who says normally up to 40 percent of patients miss them.

"It seems like almost overnight we’ve made the most progress that we’ve seen in 30 years," Hindbaugh said.

Will treatment via telehealth stick around?

Telehealth wasn’t as bad as it initially seemed, and patients and caregivers hope it will stay around, said Julie Rwan, manager of the Overdose Prevention Program at non-profit Vital Strategies.

As it stands now patients and doctors benefit from the push to telehealth, but there are still some rough edges.

"When we’re talking about supporting (equal) access in communities, that often means providing the tools for people to access telehealth," Rwan said.

Inconsistent internet access makes it tougher in rural areas and ensuring the security and privacy of patients — especially with sensitive factors that influence addiction like trauma — will always be a concern.

Drug-screening will also be difficult. Most practices require regular urine tests and pill counts to make sure patients aren’t abusing opioids or their medication. That’s harder to monitor at a distance.

"[Doctors] are not asking you to go in the bathroom and videotape when you’re giving the specimen," Pam Lynch said. "But many patients have found it amusing how easy it would be to alter."

 

Michigan's 2017 overdose death rates by county.
Credit MDHHS

There is also some recent political momentum to expand coverage of addiction treatment. The Michigan Department of Insurance and Financial Services (DFIS) could make addiction treatment an “Essential Health Benefit” that must be covered under the Affordable Care Act.

The change would specifically cover Naloxone, an injectable and inhalable drug that can stop an overdose, and Buprenorphine medications like Suboxone and Zubsolv. Representatives from DFIS say they expect the change to be approved this summer, and it would expand treatment to over 600,000 Michiganders.