Addiction to opiates is having a major impact on the health of patient populations around the country. In fact, one sobering statistic states that more Americans died in 2014-2015 from drug overdoses than died during the entire Vietnam war. Addiction is our nation’s epidemic. It’s hitting my very own patient population here in Cincinnati especially hard. Within a 6 day period this past August, we experienced an “unprecedented” 174 heroin overdoses. Combine this with the fact that we double the national average for individuals living below the poverty level and you have a challenging public health issue.
These factors, among many others, were buzzing about my mind when I was perusing this year’s Connected Health Symposium agenda. As such, the panel discussion entitled “Digital Therapies Can Offer a Breakthrough for Treating Addictions” definitely made it to my short list of sessions to attend. The panel included:
- Corey McCann, MD, PhD, CEO, Pear Therapeutics
- Judson Brewer, MD, PhD, Founder, Claritas MindSciences; Director of Research, UMASS Medical School Center for Mindfulness
- Charles Curie, MA, ACSW, Principal and Founder, The Curie Group, LLC
- Chris Pesce, Co-Founder & COO, Sober Grid
Following are some of the best insights gleaned from the panel discussion as well as some of my thoughts on how we can move the digital health bar forward to span the digital divide into areas with increased poverty.
Sober Grid Smartphone App
Sober Grid is an interesting app to consider for the 45 million people struggling with addiction in our country. In addition to the more standard features of an addiction application, peer support provided through the app remove barriers for many people that may not be able to attend a meeting. One factor that Chris Pesce said weighed heavily on the application’s development was that addiction has been treated acutely, but it is actually a chronic condition. He mentioned that relapse reaches 90% within a year of leaving treatment. However, if you treat addiction chronically, that gives patients the support they need when they need in order to prevent relapse. He also spoke of how, in the future, the application will be able to use predictive analytics to predict who may relapse and provide proactive intervention.
Here is where my thoughts, and my question to the panel, fits in. My main concern with Sober Grid is that it is only available as a smartphone app. Yes, there is 98% adoption of cellphone technology, but only just over half of the population has a smartphone. Think of the power this platform could have if it was developed within a responsive web platform similar to Patients Like Me and/or provided text message capabilities like Text4Baby. Oftentimes those of us in technology end up using our own lifestyle as the foundation for development. We need to look beyond ourselves for treatments that will matter for the entire population.
Center for Mindfullness
Judson Brewer is an addiction psychiatrist out of the Center for Mindfullness at the University of Massachusetts. This group is taking evidence based theraputetics to see how they can deliver treatments in the digital age. They have innovated around treatments for smoking cessation and eating addiction that are delivered both in person and increasingly online. He stated that there are some deficiencies in how these treatments can be delivered efficaciously following the principles behind cognitive behavioral therapy with links to outcomes.
Central Kansas Foundation
According to Charles Curie, of the 26 million inpatients this past year…wait for it…1/3 had mental health or addiction issues. For that reason, I found myself most interested in what he had to say about the Central Kansas Foundation. This group has developed protocols that include screening and intervention in the emergency room, which is a key location for screening for intervention. They have 65 employees in 7 locations, and they have drastically reduced the number of impatient stays and ED use because people are stationed in the acute areas of emergency departments and inpatient areas. The staff determines if the patients can they benefit from a brief intervention or longer treatment, and there are clear pathway to the appropriate treatment with assessment for medication.
Now, let’s imagine patient populations across the country with a framework like this matched with a peer support network with ongoing 24/7 connectedness.
Barriers to Implementation
The barriers to implementation are many. There is no lack of evidence to show the efficacy in using digital treatments for addiction, but, as I am sure you can guess, lack of reciprocity prohibits practitioners from utilizing these methods of care. The powers that be aren’t necessarily inclined to open up more codes available for reimbursement.
However, there is the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), which helps the reimbursement issue. MHPAEA requires group health plans and health insurance issuers to remove restrictions to ensure that financial requirements and treatment limitations to mental health or substance use disorders are no more strenuous than other treatments. The challenge is that reimbursement for digital care is impacted across the board. So, unless we can move the bar forward for reimbursement for connected health treatments more broadly, then we have little luck of MHPAEA moving the ball forward for addiction and mental health issues.
The Bottom Line
At the end of the session a simple set of conclusions was reached. Digital health works well for the treatment of addiction. However, we are struck by the challenge of whether these treatments can scale and whether they can be funded.