At the intersection of a pandemic and an epidemic, telemedicine revolutionizes addiction treatment.
When Dr. Ted Logan of Maine Behavioral Healthcare transitioned his substance use disorder practice to mostly telemedicine, COVID-19 was still at least three years in the future. For him, the impetus was expanding access to rural Mainers, some of whom would have to drive 100 miles or more to a clinic.
“It expanded access,” he said, adding that patients didn’t need to take a day off from work, line up a babysitter or drive in icy conditions. When another physician was ill, Logan was able to cover for him, even though they were in different regions of the state, and patients received seamless care.
Outside of rural geographies and challenging locations such as jails, telemedicine didn’t really take off until COVID-19 pushed nearly every aspect of our lives—employment, education, religious services, social gatherings and even medical care and recovery support meetings—into the virtual realm.
“For years, the technology was available but you couldn’t get people to use it,” says Gordon Smith, director of opioid response for the State of Maine. “And now telemedicine should be here to stay.”
Faced with a pandemic, the barriers to use of telemedicine—ensuring patient privacy and insurance reimbursements—were surmounted quickly. Nearly all medical insurance providers, including Medicaid, are now reimbursing for telemedicine.
Deb Poulin, senior director of substance use treatment and prevention at Maine Behavioral Healthcare, said that before the COVID-19 crisis, addiction treatment services for individuals, groups and intensive outpatient programs, were 90 percent face to face, nine percent televideo and one percent telephone. By the end of April, services were 50 percent televideo and—where there wasn’t a smartphone or a robust data plan available—50 percent telephone.
“We really worked hard at replicating what our individuals who we work with are used to but in the remote model,” Poulin says. “For some individuals, especially those who were challenged by reliable transportation and child care, this model works very well, and it’s our hope that we are able to preserve some aspects of remote care.”
Enso Recovery had already been using telemedicine with inmates at Kennebec County Jail and Two Bridges Jail in Wiscasset using a platform called Vsee, which was quickly overloaded as COVID-19 drove medical care online. Switching over to Zoom and Google Hangouts, Enso quickly moved all patient groups—not just incarcerated groups—online.
“Realistically, it was overnight,” says Steve Danzig, executive director. “As soon as this started happening, people started becoming nervous about coming into the office. You could just feel it.”
Logan, whose pre-pandemic patient load was 80 percent virtual, is now seeing his model replicated around the state. Meanwhile, due to a change in federal law as of May 15, the initial medical evaluation for medicine assisted treatment (MAT) can now happen virtually rather than in person.
“We are creating a way to match resources with people and meet people where they are at, which includes people in abusive relationships, people coming out of incarceration and people who are unemployed,” Logan says. “It’s a very important thing to feel heard and understood and that people care for you and that you have things to offer as well as receive.”
By mid-April, four out of five Penobscot Community Health Center recovery sites were offering group counseling via Zoom and receiving positive feedback from patients and providers. “They’re happy to see each other and connect,” said Amanda Gagnon, manager of recovery services.
“Since COVID-19, telehealth has become a mainstay of eatment,” says psychiatrist Vijay Amarendran, director of ddiction Services at Penobscot Community Health Center. “We want social distancing, which causes some social isolation. But there have been some success stories.”
Some patients dropped a three-hour round-trip commute, while others were able to schedule their check-in during their lunch break. And, even with all this convenience, the psychiatrist is still able to see the patient and pick up on emotional cues, making telemedicine with video more effective than a phone call.
Paul Murphy, a clinician with Maine Behavioral Healthcare, had a patient who was quite nervous about participating in group therapy. Coincidentally, groups moved to Zoom before the patient’s first session.
“Zoom made group easily accessible to him right off the bat,” Murphy says, “and it may make the transition for him into live groups easier.”
In Maine and all over the world, support meetings like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) also moved online, where it is possible to be “actually anonymous,” Murphy says, “listening to what goes on and seeing if it’s a good fit.”
That shift online was swift, though not immediate—and finding and accessing a meeting online was challenging for many in those early days and weeks. Large numbers of recovering addicts who were used to attending a meeting several days a week without fail suddenly went weeks without that support—and treatment providers saw the effects.
“That was a big loss of a support network for a lot of our patients,” Amarendran says. “We saw instability as people who had been sober for months or years took a step back—even people who didn’t relapse tended to experience more cravings, or smoke more cigarettes than before or experience more withdrawal symptoms or more depression, anxiety or social isolation.”
Examine that same glass as half full rather than half empty, and it is clear that a regular support network helps reduce cravings, depression and anxiety and prevent social isolation.
And while there are advantages to local face-to-face meetings that foster deep connections and communities, the quickly growing global network of online support is immediate and ever-present.
“Meetings are hosted all over the world at all times of day and night,” Smith says. “You can check in with people in New Zealand at 3 a.m., if that’s when you need a meeting.”