While it’s relatively easy to deliver mental health counseling remotely using telehealth, addiction treatment providers face more unique challenges in light of COVID-19.
For those in substance use disorder (SUD) recovery, in-person touch points are especially important. Social contact helps reduce a person’s risk of relapse, and many people with SUD rely on the assistance of medication, which must be picked up in person.
“For the recovery community at large, isolation can be dangerous and detrimental to an individual in recovery,” a spokesperson for American Addiction Centers (OTC: ACC) told Behavioral Health Business. “Isolation lowers dopamine levels, which is the very neurotransmitter that the person in recovery previously replenished with substances. In this state, and left to their own devices, the relapse process can begin.”
As such, it’s vital for addiction treatment providers to think outside the box to maintain social connection with patients throughout the coronavirus crisis, while also mitigating transmission risks.
For AAC, the nation’s only publicly traded addiction treatment provider, that means implementing new screening protocols, halting visitation, intensifying cleaning and limiting access to its 11 inpatient facilities, 24 outpatient centers and four sober-living residences across the country. Still, it’s operations remain up and running.
“In the midst of this pandemic, we must also be mindful of the 131 people who die every day in the U.S. from an opioid overdose,” an AAC spokesperson previously told BHB. “We have a duty to provide lifesaving care to those struggling with the disease of addiction and our doors remain open to help those in need.”
Addiction treatment providers nationwide are taking similar precautions. But in unprecedented times like these, new problems continue to arise.
To solve them, providers’ best bet is to work together, according to Bob Ferguson, National Association of Addiction Treatment Providers (NAATP) board member. Ferguson shared his thoughts on a recent NAATP webinar.
“My team is struggling with a few [coronavirus-related] things,” he said. “The first thing they do is call other providers and say, ‘We can’t figure this out. What do you have on this?’”
Ferguson is the founder of two addiction treatment businesses — Jaywalker Lodge, a Carbondale, Colorado-based residential recovery community, and Alpha180, a Austin, Texas-based lifestyle support program which also provides residential care. He currently serves as the CEO of the latter.
While his organizations are leaning into increased cleaning, emergency planning and communication, they’re also doing their best to turn lemons into lemonade and keep spirits high.
“Look, shelter in place is a protocol that was developed for school shootings,” he said. “Of course it sucks. Nobody wants this. Now, how can we make it better?”
The answer could be as simple as PlayStations and Pelotons, two additions Ferguson said residential clients have requested as they “hunker down for the next leg of this journey.”
“We’re going outside for activities in the morning and in the afternoon,” Ferguson said. “It’s PlayStations and Pelotons on the way. [It’s] changing one of our group rooms into … a game room. We’re upping our subscription on Netflix.”
In the inpatient and residential settings, those sort of lifestyle changes are easy enough to make. Additionally, providers have the control to restrict visitation and ensure patients still get the medication-assisted treatment (MAT) services they need.
Meanwhile, for outpatient providers, things are trickier. They can’t control where patients coming into the clinic have been — or if they come in at all.
For example, Recovery Centers of America (RCA) — a King of Prussia, Pennsylvania-based addiction treatment provider with seven inpatient facilities and 10 outpatient facilities across Maryland, Pennsylvania, New Jersey and Massachusetts — has seen no-show rates increase at its outpatient facilities amid COVID-19, CEO Brian O’Neill recently told BHB.
“People are quarantining at home and not coming in as much,” O’Neill said, noting that RCA’s outpatient facilities remain open. “We’re beginning to rely on our IT department to create telehealth capabilities.”
In light of COVID-19, the federal government has loosened telehealth regulations to make it easier for behavioral health providers to deliver services remotely. Many of those changes are relevant for SUD treatment providers specifically.
For example, the Drug Enforcement Administration (DEA) is allowing licensed clinicians to prescribe drugs to patients following virtual visits, even if they’ve never seen the patient in person. The change gives SUD treatment providers the capability to prescribe some MAT medications virtually.
Additionally, SAMHSA has relaxed regulations so providers can send patients home with more MAT medication at a time, therefore allowing providers to cut down on person-to-person contact without impacting treatment. Stable patients can now take home 28 days worth of medication at a time, while others can be OK’d for a 14 day supply.
The feds have also loosened rules for HIPAA and 42 CFR Part 2, a regulation that restricts what information addiction treatment providers can share with other health care professionals without patient permission.
But the new federal flexibilities may not be enough, some say.
“It’s helping providers feel like we’re being supported by our government,” Sarah Johnson, chief medical officer at Landmark Recovery, said. “But an issue that many providers, including myself, have struggled with is being comfortable with the loosened guidelines because state guidelines have not been changed as quickly.”
Landmark Recovery is an addiction treatment provider with four residential facilities across Indiana, Kentucky and Oklahoma. Most patients start at the detox level of care.
“Initially when we had to change our visitation policies, … we had a higher than normal discharge rate,” Johnson said, noting that Landmark has taken many of the same precautions as other providers. “But our admissions haven’t really slowed down, and our numbers have held pretty steady.”
Still, Johnson believes all providers, including Landmark, would benefit if states and regulatory bodies would speak up and made their expectations clear.
“I think that it would be really helpful in [making] providers feel more secure in practicing under the relaxed regulations if state governments and state medical boards could align with the federal standards and make that clear to their providers,” Johnson said.