Q&A: Bicycle Health CMO breaks down telehealth’s role in the opioid crisis

The opioid overdose crisis has come to a head in the United States, with pharmaceutical manufacturers, pharmacies and physicians all being hit with dozens of lawsuits for their roles––and paying out millions in settlements.

The COVID-19 pandemic had a profound impact on the crisis, with many people unable to access their doctor’s offices and treatment centers. As a result of temporary closures, demand for telehealth skyrocketed during the early days of the pandemic, including opioid use disorder (OUD). 

Health Exec caught up with Brian Clear, MD, chief medical officer with Bicycle Health, a provider of virtual treatment for OUD to patients across 29 states. Clear filled us in on the current state of the opioid overdose crisis and the role of telehealth in the crisis. 

This interview has been edited for length.

Health Exec: What’s the current status of the opioid crisis in the United States, and what has been the impact of the COVID-19 pandemic on OUD?

Dr. Brian Clear: The CDC’s release of new data shows a dramatic and record-breaking increase in opioid-related deaths. At 80,816 lives lost in 2021, the annual death toll approaches COVID’s. Not to mention, opioids killed more Americans than car crashes and flu combined in 2021. The COVID-19 pandemic presented unique challenges for people with substance use disorders and in recovery. This included health impacts from COVID-19 itself, to secondary influences such as mental health needs, stress, loss of work and caring for loved ones. To address the growing need for socially-distanced care, the U.S. government waived restrictions for telehealth services, enabling Bicycle Health to expand its services to thousands of new patients. 

Fast forward to today, and the opioid crisis is finally getting the attention it deserves. The Biden administration recently allocated $1.5 billion in grants to fight the opioid crisis and expanded access to medication such as buprenorphine and methadone to treat substance use disorders in pregnant women. But some crucial barriers still remain and it’s our job to break down those barriers to get care for as many people as possible.

Health Exec: We’re seeing more litigation and settlements against those involved in the opioid abuse epidemic (ie drugmakers, pharmacies), is this having an impact on improving opioid abuse?

BC: In 2017, U.S. physicians wrote over 3 times more prescriptions for opioids than they did in 1999. I’m glad to see that recent litigation and settlements are shedding light on the malpractice of negligent opioid prescribing, but regardless, there will be patients that will be seeking treatment.

Health Exec: What’s the role of telehealth in the opioid epidemic?

BC: Opioid recovery is not designed for the vast majority of patient experiences in the U.S. Traditional recovery centers and rehabilitation facilities can cost upwards of thousands of dollars, barring many from attending. Not to mention, 30% percent of rural Americans live in a county without a buprenorphine-waivered provider––the most effective and safe medication to treat OUD––compared to only 2% percent of urban Americans. 

Many treatment plans require extensive time spent in a facility, prohibiting those who are unable to take time away from their jobs or caregiving roles. Overall, most in-person treatment options are not created to fit the lifestyles of their patients. This is where telehealth has transformed the landscape, allowing people across the country to engage in personalized treatment from their own home––without geographic barriers, the stigma of seeking in-person care or costs of traditional clinics that are at least $250 per visit without support groups and other resources. Treatment via telehealth can ultimately lead to stronger long-term outcomes, less relapses and better quality of life. 

Health Exec: How does telehealth differ from in-person care for those seeking OUD treatment?

BC: A growing body of research points to positive patient experiences with telehealth versus in-person care for OUD treatment. In my experience running a telehealth medical group centered around Addiction Medicine, we’ve developed a high-quality practice where nearly 80% of patients continue to engage in care beyond 90 days. That compares to a large review of claims data, which found that the in-person industry average retention rate for insured patients was only 44% at 90 days.

Particularly in rural communities, in-person care for OUD remains difficult to access and programs are often sparse, so care quality can be unpredictable. This can come with a stigma that pushes people away from seeking care, and doesn’t coincide with their working schedule or family life. When receiving in-person care, I’ve noticed that patients often succumb quickly to discouragement, with about half leaving care within 90 days and most returning to problematic use. Telemedicine gives patients more of a choice to access confidential, high-quality programs without taking time off from work. 

Health Exec: During the height of the pandemic, telehealth saw demand rise sharply. How have you seen business change since early-to-mid 2020? Higher demand on the patient side, more awareness about telehealth options, more support from government agencies?

BC: The pandemic brought telehealth to the forefront of the conversation, as it became a necessary means to treat patients across the country. However, some states are beginning to roll back pandemic-era waivers that allowed for the tele-Rx of MOUD. This means hundreds of Bicycle Health’s patients are losing access to life-saving medication.