Narcotic-addiction treatment, delivered digitally, is on the rise
The opioid epidemic is ravishing corners of the United States, with an average of 130 Americans dying every day due to overdoses. In San Francisco, an estimated 24,500 injection drug users live in the city.
One of the main issues in fighting the crisis: only about one-fifth of the people who need treatment actually get it, primarily due to a shortage of primary physicians trained to provide quality treatment and the hurdles addicts need to jump through in order to get help, like taking off from work or traveling several miles to the nearest clinic. As with any crisis these days, a slew of tech companies are trying to tackle the epidemic. The idea: use tech to reach more people and make it easier for them to get help. But legacy treatment centers and experts aren’t so sure a digital solution is the right one.
Workit Health, a startup founded in Oakland and now headquartered in Michigan, is one of the major new companies in the space, founded in 2015 by Robin McIntosh and Lisa McLaughlin. The two met in Alcoholics Anonymous in San Francisco and have lost several friends to substance abuse.
“In AA, they have this saying that you should buy a black dress because you’re going to be wearing it a lot,” McIntosh said.
The company offers people three different program options (ranging from $25 to $75 a week) that can include a variety of offerings, such as an interactive online curriculum that helps people work through self-defeating thoughts, peer coaching, group sessions, and drug counseling with a licensed mental health professional via video chat.
“Basically, we directly deliver everything that you can get from an outpatient service,” said McIntosh.
With the most popular option (at $75 a week), people are able to receive medication-assisted treatment (MAT) — now widely considered the most effective form of intervention — which involves the prescription of FDA-approved medications such as methadone, naltrexone, and buprenorphine to reduce the physical symptoms of opioid withdrawal.
The question the industry is asking: Should digital tools be treated as a source of support for patients in between visits to traditional in-person treatment facilities, or do they offer sufficient treatment by themselves?
Studies have shown that addicts are half as likely to die from an overdose when their treatment plan includes long-term access to a MAT drug. Los Angeles police are now even being given these types of medicines to distribute to help fight the crisis.
A slew of other digital addiction-treatment options, including sobriety trackers, reminder notifications, and interactive exercises to increase mindfulness around substance use, have cropped up. In 2018, Pear Therapeutics received FDA approval for their mobile tool, reSET-O, which provides interactive lessons and quizzes to help recovering addicts identify their craving triggers and practice drug-refusal skills. A-CHESS, a program by Geisinger Health System, also provides similar cognitive-behavioral exercises through a digital interface.
But Workit Health’s ability to give peer and professional counseling through primarily digital means, along with medication to treat addiction, is a relatively new concept.
The question the industry is asking: Should digital tools be treated as a source of support for patients in between visits to traditional in-person treatment facilities, or do they offer sufficient treatment by themselves?
Directors of conventional rehabilitation programs are wary of fully embracing online programs to treat various addiction problems. Keith Weber, marketing and development coordinator for Ohlhoff Rehab Programs of San Francisco, one of the oldest addiction treatment centers in the city, is cautious about the idea of people who are struggling with life-threatening addictions relying on technology.
“These tools might be helpful for some people, but what we’ve seen for the 68 years that we have been around is that [in-person treatment] is what works,” Weber said.
Arlene Stanich-Prince, executive director of the center, with over 14 years of experience as a drug and alcohol counselor, agrees.
“It’s hard enough in outpatient when a person isn’t there 24/7,” Stanich-Prince said. “I think you really need to work with a person face-to-face because honesty is huge.”
“I knew I couldn’t afford to take any downtime from my job, so an inpatient clinic was out of the question.”
Indeed, many addicts find that an in-person experience is essential to their recovery process. Sarah B., a 34-year-old education employee who wished to remain anonymous, has found success in using Workit Health for about six months so far after she found herself slipping into a burgeoning dependence on painkillers during post-surgery recovery. But she’s still considering supplementing the program with extra support by attending in-person events in her community.
Sarah B. found that the combination of services was useful for her, especially the ability to get MAT treatment. As of early June, she is 180 days sober and hasn’t had a relapse since she started MAT.
Despite the success of MAT programs, they’re relatively uncommon in legacy treatment models — 90 percent of treatment options are centered on a counseling-only abstinence-based model that’s been the gold standard for addiction recovery in the United States since the 1930s. Getting MAT drugs also often requires going through specialty clinics, which can be inconvenient to access, especially in rural parts of the US that have been hit the hardest by the opioid epidemic. People are also often expected to line up early in the morning each day outside regional clinics — a task that seems unmanageable for anyone, let alone those with a serious drug addiction.
Sarah B. also said that the ability to use Workit Health remotely was key.
“I knew I couldn’t afford to take any downtime from my job, so an inpatient clinic was out of the question,” she said. “Some clinics require daily check-ins, which can be impossible if you’re working.”
McIntosh says that that’s a common sentiment. While she wishes everyone battling addiction could enroll in a prolonged recovery program like the one Ohlhoff offers, it’s not realistic. People often have to choose between getting help or sacrificing jobs and daily routines for a prolonged period of time. Plus, there’s the issue of affordability.
Many insurance companies often get away with shirking coverage of drug rehabilitation, so these in-person programs can cost anywhere from $20,000 to $30,000 out of pocket, she said. In addition, addicts who get a moment of inspiration to quit are often disappointed to find out that the next appointment to see a drug counselor or therapist may be weeks away.
“We are asking the most vulnerable people to do the most difficult things,” McIntosh said. “Too many people need help because of the gravity of the opioid epidemic, and they are not getting it. Until now, we’ve never looked at addiction treatment and thought to modernize it.”