Opioid addiction and overdose-related deaths reached an all-time high in 2022. The opioid crisis has strained health systems, overwhelmed emergency responders and placed a heavy burden on social services.

THE PROBLEM

Before the advent of telehealth in addiction treatment, people seeking medical help for opioid use disorder faced several challenges that limited their access to care. Dr. Robin Arthur Williams, chief medical officer at Ophelia, a telehealth provider that cares for OUD patients, spells out the challenges:

• Geography. Many individuals with OUD live in rural or remote areas where specialized addiction treatment services are scarce or nonexistent. The lack of nearby treatment facilities requires individuals to travel long distances, sometimes across state lines, to access appropriate care. This poses significant barriers, especially for those without reliable transportation or the financial means to cover travel expenses.

• Limited availability of providers. There is a shortage of healthcare providers who specialize in addiction, ones trained and certified to provide evidence-based treatment for OUD. This scarcity of qualified providers has led to long waiting times for appointments. The delay makes it challenging for individuals to receive timely care, particularly during critical moments when immediate intervention is necessary.

• Stigma and fear of disclosure. The stigma surrounding substance use disorders, including OUD, has prevented many individuals from seeking treatment. Fear of judgment, discrimination or the potential consequences of disclosing their condition often deters individuals from reaching out for help. The lack of privacy and confidentiality in traditional healthcare settings further exacerbates these concerns.

• Time constraints and inflexible scheduling. Two-thirds of OUD patients have jobs or rely on childcare, making regular clinic visits, mandated group therapies and traditional rehab impossible. In-person treatment often requires individuals to take time off work, school or other responsibilities to attend appointments. This poses difficulties for individuals who have limited flexibility or face financial repercussions from missing work.

• Financial resources. The cost of treatment for OUD can be a significant barrier for many individuals, especially those without insurance coverage or limited financial resources. The expenses associated with in-person visits, transportation, medications and counseling sessions could be prohibitive, and make treatment unaffordable for some.

PROPOSAL

Ophelia is a digital provider of medication-assisted treatment (MAT) for OUD, committed to making evidence-based treatment universally accessible. Ophelia is licensed to provide care in 36 states and contracted with Medicaid, Medicare and commercial insurers covering 85 million American lives.

"Before launching in 2019, we knew telehealth had the potential to play a significant role in supporting individuals struggling with OUD by expanding access to MAT, particularly for those living in rural or underserved areas," said Williams.

"For context, it’s important to understand that MAT is considered the gold standard of care for OUD by the CDC, SAMHSA, AMA and ASAM," he added. "Many studies have shown the efficacy and safety of this treatment, which reduces overdoses by 76% and ER visits by 32%."

Simply put, MAT saves lives, he added. But because legacy addiction care is a $42 billion business, the use of medications like buprenorphine, which can be administered during a simple visit to a provider, continues to be de-emphasized.

"Traditional rehabs cycle patients in and out, promote morality-based abstinence-only programs, and profit on relapse," said Williams. "Treatment plans without MAT lead to a 90% relapse rate within three months.

"In addition, traditional, in-patient rehab requires putting your life on hold, leaving your environment, and living elsewhere for months, which just isn’t feasible for most people," he continued. "We believed that providers could prescribe and monitor medication, offer counseling sessions, and adjust treatment plans remotely to support individuals in their recovery journey."

Providers would also be able to offer convenient follow-up care for patients to monitor progress, address concerns and provide ongoing support, he added. This helps prevent relapse, increase medication adherence and promote long-term recovery, he said.

"One of the biggest benefits that virtual care offers people with OUD is alleviating the stigma associated with seeking treatment for OUD," he noted. "By receiving care in the privacy and comfort of their own homes, patients don’t need to worry about judgment or disclosure of their condition in a public setting."

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MEETING THE CHALLENGE

Ophelia’s mission is to make evidence-based treatment universally accessible to anyone struggling with OUD, with a special commitment to serving the Medicaid population, often overlooked despite its disproportionately high rate of OUD.

"While other addiction treatment providers rely on referrals from hospitals or primary care providers, Ophelia takes a different approach, recruiting patients directly online and creating a platform to mobilize unutilized clinicians," Williams explained. "This is critical to reaching 'the invisible 80%' of Americans with OUD who are unengaged with the healthcare system until a dangerous complication occurs.

"As such, Ophelia created a digitally native clinical model, which adapts the widely successful Massachusetts Collaborative Care Model to telemedicine," he continued. "By combining team-based care with a clinician training program and collaborative clinical software, Ophelia creates treatment opportunities for the more than 50,000 licensed MAT clinicians who previously had no way of treating patients due to a lack of infrastructure."

Ophelia treated its first patient in early 2020, and has since seen rapid adoption by both patients and clinicians. Today it is licensed to provide care in 36 states and has national and regional insurance contracts covering 85 million lives, including bundled rates across Medicaid, Medicare and commercial populations.

RESULTS

Ophelia recently shared findings from its poster presentation at the Annual ASAM Conference that revealed home-based buprenorphine inductions guided by telehealth are both feasible and well tolerated.

"More than 90% of patients returned for one or more follow-up sessions and more than 80% met HEDIS engagement criteria, including attending two or more visits within 34 days of intake," Williams reported.

"The data also suggest that patients using fentanyl can be successfully induced with buprenorphine using a protocol that emphasizes: a low initial buprenorphine dose, rapid titration to a target dose, proactively used comfort medications and close follow-up during buprenorphine dose titration.

"Another Ophelia study, published in The American Journal of Drug and Alcohol Abuse, demonstrated that opioid users receiving MAT via telehealth have a high rate of remaining in treatment," he continued. "We found that 56.4% of Ophelia’s patients remained in treatment for six months, and 48.3% remained for one year – those retention rates are significantly higher than traditional in-person care."

The study also revealed that telehealth patient retention rates are higher than a previously studied multistate in-person patient population (using the same visit-based retention definition). Despite hypothesizing that retention would be lower among racial/ethnic minorities and rural patients, the study found no significant associations between sex, race/ethnicity, state or rurality with treatment retention.

"These groundbreaking results point to the long-term promise of telehealth-based medication-assisted treatment for OUD," Williams stated. "It also may be incredibly impactful for patients who traditionally had difficulties accessing care.

"These study findings help take another step forward in proving what we already know: telehealth-based medication-assisted treatment for opioid use disorder is highly effective in reducing overdoses and preventing relapse," he said.

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