Summary: Those living with opioid use disorder are generally hesitant to seek medical help. However, covid-19 epidemic has only made things worse. Thus, policymakers legalized providing medical care to those living with OUD via telehealth. However, there have been some concerns regarding the decision. The new study shows that telehealth is beneficial for those living with OUD and is associated with a reduced risk of overdose events. This underscores the importance of telehealth in providing treatment and care for opioid addiction treatment.

The scale and extent of covid-19 pandemic took everyone by surprise. The world was not ready for the pandemic. This created many challenges. It made providing medical help to a specific group of patients more difficult. Moreover, due to covid-19, people got confined to homes and traveled less often. It also means that covid-19 related restrictions created a barrier to seeking medical help.

 

It is no secret the those living with opioid use disorder (OUD) are less likely to seek medical help. There are many reasons, from social stigma to disbelief in the system. For such individuals, things became even more difficult during the pandemic times.

Fortunately, US policymakers realized this challenge faced by people living with OUD and legalized telehealth for OUD. It means that for the first time, doctors could legally prescribe opioids used to manage OUD without seeing a patient. However, this change in policy was not well received by everyone. Many were skeptical of such a change and worried that it might even make the ongoing opioid overdose epidemic worst, as opioids would become more accessible for many.

Fortunately, a new study shows that these policy changes have been beneficial and resulted in reduced risk of overdose. The study was carried out by researchers from CDC, NIDA, NIH, and CMS. The results of the study were published in the journal JAMA Psychiatry.

In the study, researchers analyzed the data of 175,778 Medicare beneficiaries from September 2018 to February 2021. They focused on analyzing the events of an overdose in those who received medications for opioid use disorder (MOUD) through telehealth during the pandemic.

They had several interesting findings:

• They found that there was a sudden upsurge in people seeking telehealth services for OUD. Thus, these numbers increased from 0.6% to 19.6% during the pandemic.
• Interestingly, they also found that people receiving telehealth care were more likely to receive MOUD, which was 12.6% for telehealth. In contrast, these numbers were 10.8% for those who visited the doctors.
• Telehealth services had many positive effects on patient care. Thus, those treated for OUD were more likely to stick to their treatment. In addition, patients were less likely to overdose on their drugs.

Researchers say that their findings show that telehealth services helped overcome the barrier to medical care for addiction. This barrier to seeking medical help is among the most important reasons why many do not seek medical help. Lack of treatment and support naturally means a greater risk of a drug overdose. 

Researchers say that there is clear evidence of the benefit of telehealth. It is not just good for patients; it can be lifesaving for many. In addition, it is clear that telehealth can have many long-term positive effects on patients.

The study also noted some disparities due to an existing digital divide. Thus, non-Hispanic black people were less likely to seek tele help. Therefore, countering this digital divide is vital for fully exploiting the benefits of telehealth.

Researchers say that though the covid-19 pandemic has created many challenges for the healthcare system, it has also provided opportunities for investigating various ways of providing healthcare.

To sum up, this study is supportive of telehealth for OUD, and it shows that these services must be continued even in the post-pandemic era. 

Summary: Opioid crisis and opiate abuse have only worsened in recent years, despite declining rates of opioid prescription. It is no secret that many people living with OUD are not seeking treatment. There are many causes for people not seeking treatment, like clinics not taking new patients, or many are just hesitant to seek treatment. However, telemedicine now offers hope. Doctors can not only treat OUD through online apps or platforms but also prescribe drugs like suboxone, which is a combination of buprenorphine and naloxone.

It is no secret that there are many reasons why so many people are not getting OUD treatment. One of the reasons is that there are just not enough clinics and specialists to treat the condition. In addition, many clinics are not taking new patients, and there are long waiting times.

Another, perhaps, even more significant reason is that those living with any kind of addiction do not want to go to clinics. There is much hesitance. They think that others would not understand their problem or simply do not want to travel, seek help, and more.

However, what if we said that now you can get opioid treatment programs online and prescription for medications? Finally, many states have approved the use of telemedicine in treating OUD. It is the right step, considering the scale of the problem.

Moreover, for most people living with opioid addiction, privacy is also a significant reason for not seeking help. Now they can expect to get treatment in the privacy of their home and even expect to get prescription medication.

Many clinics have now launched online OUD treatment services, which are completely legal. But, of course, there are some requirements to be fulfilled. For example, DEA has made it necessary that patients should undergo live video interviews with healthcare providers and not consult via chat. These limitations are just for the first time, as later, one can keep in touch with the clinics through other means.

Currently, a drug called suboxone is approved for treating addiction through telemedicine. It means that doctors can prescribe this to those living with OUD without the need to visit a clinic. It is among the most effective drugs to treat OUD, and it is a combination of buprenorphine and naloxone.

Suboxone is a very interesting medication and quite effective due to its unique mode of action. For example, buprenorphine works almost in the same way on opioid receptors as oxycodone. However, its activity is much less. Naloxone, on the other hand, blocks the effects of opioids.

Generally, naloxone is not used along with opioids like medications due to the risk of some severe side effects. However, it seems that combining it with buprenorphine is safe and good. Such a combination help overcome withdrawal syndrome quite effectively and, at the same time, block some of the unpleasant effects of prolonged opioid use. Hence, it is among the most effective ways to recover.

Online suboxone prescription is legal, but not in all states. Thus, if you are looking for a suboxone treatment option, you would need to check if online it is legal in your state. Of course, it is worth understanding that things are changing fast, and it is becoming legal in an increasing number of states. Thus, checking the latest information is always a good idea.

Of course, there are some other limitations of this kind of treatment. Besides the first online video interview, doctors would regularly ask you to get tested for opioid use. They would often send you a testing kit, and you will need to carry out the required tests, or else doctors can stop prescribing suboxone. These are some of DEA’s strict requirements, and everyone must stick to them.

Here it is vital to understand one more important thing; if suboxone online prescribing is legal in your state, it does not mean that just any doctor can prescribe it. Buprenorphine is still a controlled substance; thus, clinicians need to obtain a special waiver from the Substance Abuse and Mental Health Services Administration (SAMHSA).

Moreover, to avoid any pain killer addiction, there has to be a strict dosage prescription policy , both by the patient and the doctor.

Summary: Chronic pain is among the most common comorbidities in those being treated for opioid use disorder (OUD). However, a new study found that in most cases, doctors treating OUD do not pay sufficient attention to chronic pain management, resulting in higher opioid relapse. They also found that those treated with medications like methadone or buprenorphine had better pain relief and, thus, better treatment outcomes. Therefore, researchers recommend that doctors focus on managing comorbidities when treating OUD.

When we think of people living with OUD, we completely neglect that many of them live with severe chronic pain such as, neck pain, complex regional pain syndrome, etc. This poorly managed chronic pain may be related to poor treatment outcomes in many. Studies show that chronic pain is the most common comorbid condition in those living with OUD.

 

Recently, the Journal of Pain published a patient survey, finding that two-thirds of those treated for OUD reported that their chronic pain was not managed well. Even worse, 47% reported that their pain worsened over time, thus increasing the risk of opioid relapse.

 

The opioid crisis continues to be a significant health problem, and it is showing no sign of slowing down. Moreover, the coronavirus pandemic only increased opioid use disorder (OUD) and drug overdose-related deaths. This only underlines the need to pay more attention to the effective opioid addiction treatment.

 

Health experts say that the problem in tackling the opioid crisis is not just in lack of access to opioid treatment, which is true. Still, other factors make treatment more difficult and result in high relapse rates. In addition, most people treated with OUD have other comorbidities, with many living with mental health issues and chronic pain.

 

Although it is no secret that chronic pain and OUD are related health issues. However, it is unknown how ill-managed pain in those living with OUD may affect treatment outcomes for the condition. Health experts say that one of the problems is that treating doctors focus significantly on OUD, but less on comorbidities, especially issues like chronic pain.

 

In the new survey, researchers analyzed the data of 14,449 patients getting treated in 225 OUD treatment centers. They found that one-third of all the patients had significant chronic pain. Out of these patients, just one-third reported that their chronic pain was managed properly with pharmaceutical drugs. Moreover, almost half of all the patients said the pain was the primary reason for opioid relapse.

 

Researchers say this is a massive sample size, and they were amazed to see that so many patients are not being treated adequately for their chronic pain. Many of these patients have even used street drugs like heroin to manage their pain.

 

When researchers interacted with doctors treating OUD, they were often told that treating pain was not their priority or not within the scope of their practice.

 

Researchers say that there is a need to understand that pain is among the most significant causes of opioid relapse. Hence, effective treatment of OUD must include adequate pain relief.

 

The study had another unexpected finding related to opioid relapse. In the survey, 20% of those treated for OUD said that they would return to opioid use once they overcame their addiction. It means that treatments are not preparing them well for post-treatment life, and many of them still view opioid use as an option.

 

The study also found that those treated with OUD with medications had a higher success rate. Thus, those treated with buprenorphine and methadone reported better treatment satisfaction. It seems that one of the reasons for a greater success rate with these medications is that they also help with chronic pain treatment.

 

Thus, health experts say addiction treatment will only improve if different health specialists work together. Moreover, the coronavirus pandemic has shown that interdisciplinary collaboration using technologies like telemedicine is not that difficult.

 

Of course, researchers say that the study has also raised certain questions, like the role of opioids in pain management. As a result, the researchers suggest that the use of opioids for managing chronic pain should be limited.

 

Additionally, researchers say that one of the issues is that doctors often do not view chronic pain as one of the significant issues. They forget that this pain may be due to comorbidities like depression and mood disorders requiring treatment. If these comorbidities remain unmanaged, relapse is more likely.

 

Hence, researchers concluded that OUD should be treated by multi-specialist teams, including pain management, psychiatry, psychology, integrative medicine, and physical therapy. In addition, we should treat the patient as a whole and not merely focus on reducing pain numbers on a scale.

Summary: Despite a decline in opioid prescriptions, the opioid crisis continues. Opioid use disorder (OUD) and deaths due to opioid overdose continue to increase. Thus, researchers say that there is a need to develop a better understanding of opioid dependence and avoid oversimplification of the problem. So though an increase in opioid prescriptions initially fueled the crisis, later, other factors came into play, like pill mills and an increased supply of illegally produced opioids. 

The opioid crisis is not new, but it is not showing any signs of fading despite the best efforts of regulatory agencies and medical practitioners. What is worrisome is the upward trend of opioid overdose-related deaths, despite a significant decline in opioid prescriptions in the last few years. In addition, it appears that many are now procuring and using prescription opioids produced illicitly. 

Researchers think that if we want to counter this crisis, we need to understand the complex nature of the opioid crisis. Things are not as simple as they might appear. This crisis is not fueled much by opioid prescriptions by doctors to manage chronic pain. Instead, there are other factors like pill mills and “unscrupulous” physicians fueling opioid use disorder (OUD). This pathway that is fueling OUD exists outside the domain of chronic pain management. 

Though there are indeed many faces of the opioid crisis, and it is among the most complex health crisis causing physical and psychiatric health issues. Still, it is also worth understanding that the drug landscape is continually changing. Therefore, what researchers warn is against the oversimplification of the problem. 

For example, saying that the epidemic is solely fueled by opioids prescribed to manage chronic pain is just an oversimplification. On the contrary, studies show that when opioids are prescribed for managing chronic pain, very few patients abuse these drugs. Hence, opioids prescribed by doctors to manage chronic pain do not contribute much to OUD.

Similarly, initially, this factor played a role in OUD development since prescription drugs were cheaper options. However, this factor is not relevant anymore. Though pill mills continue to contribute to the crisis, they are not the only source.

It is true that initially, opioid prescription played a significant role in the opioid epidemic. The epidemic had a humble beginning, as the doctors wanted to help their patients living with chronic pain. Thus, they started prescribing opioids to many patients. However, soon opioid demand rose, and many started procuring these drugs from the illicit market. Due to high demand, the market got filled with illegal drugs. This also affected the market for illicit drugs as it shifted from heroin from Asia to illicitly produced fentanyl in Latin America.

However, researchers say we cannot blame pill mills and unscrupulous physicians alone. Many hospitals continue to prescribe opioids even for conditions with little benefit from opioid prescriptions. 

Since the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain, opioid prescriptions have fallen. Nonetheless, opioid prescriptions remain relatively high in the US compared to other nations worldwide. In addition, studies now confirm that 90% of those living with OUD often use these drugs for non-medical reasons.

Though studies suggest that very few people prescribed opioids for chronic pain will ever develop OUD, this is still a significant number. Moreover, studies show that the number of people older than 50 seeking treatment for OUD has continuously increased. People of this age group are more likely to source opioids from physicians.

Similarly, it is still poorly understood why some individuals are more likely to develop OUD. Nonetheless, researchers think that there is no single explanation. Most of those who develop OUD are individuals who already have other psychiatric comorbidities apart from chronic pain. Thus, this group of people is more likely to develop OUD. Consequently, they not only keep using prescription opioids but are also pretty likely to buy illicit drugs.

To sum up, the researcher says that though specific techniques like using electronic health record notification and motivational interviewing along with opioid dependence treatment  may help reduce the risk of OUD, much work still has to be done to understand the causes of OUD.

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Medical Disclaimer: Keep in mind that the content provided is not direct medical advice for patient care, but is provided for thoughtful discussion.