“I got brave and made the call”: Telemedicine Allows for Opioid Addiction Treatment from Home
For years, Maryann sunk ever deeper into an opioid addiction, crushing and snorting a half-dozen pills a day, vomiting from withdrawal when she couldn’t find drugs on the street.
Then, the coronavirus struck. Overcome with anxiety, Maryann — a heart-attack survivor who takes immune-suppressing medication — was soon snorting 15 pills a day.
She knew she needed help, but leaving the house, even to buy food at Wal-Mart, stressed her out. Walking into a treatment clinic was, and still is, out of the question.
“It scares me when I have to go out and play Russian roulette with my life,” says Maryann, 53, who lives in Montana.
Now, thanks to Ideal Option’s new telemedicine program, Maryann is finally getting help.
In response to the coronavirus pandemic, the federal government has lifted restrictions on the use of virtual appointments for new patients seeking medication assisted treatment (MAT).
Now, both new and existing patients can receive life-saving treatment from home, simply by using a phone or tablet.
“In the past rural communities have had trouble finding providers — we’ve had folks driving 200 miles to be seen,” says Ken Egli, M.D., Ideal Option’s co-founder and medical director. “Now we have providers in cities seeing patients in rural communities. Appointments are safer and more convenient for our city patients, too.”
Maryann says the option to enroll from the safety of her bedroom made all the difference.
“I got brave and made the call. It took me a good seven or eight days, but I was so relieved when I did it. I was proud of myself.”
In recent months, Ideal Option has seen an influx of new patients like Maryann: folks who have reached their breaking point during the Covid pandemic, who’ve finally realized that maintaining their addiction is just too hard, too dangerous, or both
“People who were still functioning with their addiction suddenly can’t get pills from their doctor for ‘back pain’ or whatever reason they gave, and hospitals are doing emergency treatment only,” Dr. Egli says.
Lockdowns and travel restrictions have disrupted opioid supplies from China and Mexico, as well as delivery from local dealers, so people with opioid use disorder (OUD) have less access to their substance of choice. Many have been thrown into miserable and dangerous withdrawals. Throughout the country, counties are seeing a spike in opioid overdoses and deaths.
“It’s gotten scary out there,” says Geoff Godfrey, ARNP, an advanced nurse practitioner with Ideal Option. “People are saying, ‘I’m tired of getting thrown in jail again and again, and now if I get thrown in jail, the chance of getting Covid is high. People are starting to think more clearly about their future and deciding to seek treatment.”
Stacy, 37, a single mom in Maryland, is among those who’ve sought treatment via telemedicine during the pandemic.
“I lost my house, my car was repossessed — opioids took my whole life away from me,” says Stacy, who now takes Suboxone.
During her addiction, Stacy sold her food stamps for pills and suffered withdrawal while working at a warehouse.
“I was constantly sweating, I was so ungodly cold, and I felt like a million spiders were crawling all over me,” she recalls. “I had no energy at all. Bending over to tie my shoe made me feel like I ran 6 miles.”
Meanwhile, she was neglecting her 2-year-old daughter and teenage son.
“I’d heat up a can of ravioli, put up a safety gate for my daughter and fall back asleep,” she says. “I’d tell my son: ‘I don’t feel good right now.’”
At one point Stacy found help from a doctor who offered MAT, but his hours didn’t work with her job, and he didn’t accept her insurance. Soon she was buying pills on the street.
By the time the pandemic hit, she was tired of chasing pills, battling withdrawal, and bouncing between addiction and sobriety. She landed a job at Wal-Mart during the pandemic and knew she couldn’t blow the chance to provide for her kids and turn her life around.
“I knew I had to find a program, so I wouldn’t ever mess up again,” she says. “I have too many people depending on me.”
Still, she faced obstacles to attending appointments in person: her erratic work schedule and her immune-compromised daughter, who relies on a feeding tube.
“With the coronavirus out there, I prefer not to take my daughter out of the house,” Stacy says. “She can’t wear a mask, and I don’t want to sit in a doctor’s office with 10 other people waiting for a half hour.”
Telemedicine has been the perfect solution. “I literally called Ideal Option, was told what time to log on, and had my appointment. It went totally smoothly.”
On daily Suboxone, Stacy says, she feels fully able to manage her hectic job and her household.
In the past if she was having a bad day or felt tired, the first thing on her mind was: I wish I could get high.
But thanks to MAT she’s lost those cravings. For the first time in ages, she says, “I feel normal.”
While telemedicine has allowed new patients like Stacy to seek treatment, it’s also made it easier and safer for existing patients to comply with their treatment schedule. Virtual appointments provide both accountability and human interaction, a combination that’s saving many from relapse during this stressful time.
“This pandemic is especially hard on our patients,” Dr. Egli says. “A lot of them are losing their jobs and feeling isolated, and 12-step meetings have moved online. It’s hard enough to walk into a 12-step group and meet people, and now you have to add the technology component.”
To be sure, there are tradeoffs with telemedicine. Patients do need to manage some technology (although the app required is not complicated). And when patients and providers are separated by screens, reading body language is more challenging on both ends.
But Geoff says this challenge has prompted him to up his game as a provider.
“Sometimes in person, you’re so busy typing notes that you don’t even look at their face,” he says. “With telemedicine, you’re forced to look into their eyes and really listen to their words. I feel that in the throes of this pandemic, my practice of medicine is stepping up.”
Geoff says some of his long-time patients seem more at ease during virtual appointments; with the screen as a buffer, they’re more apt to speak more honestly.
“I’m seeing more and more willingness from patients who have been reticent,” says Geoff Godfrey. “Now they’re just blurting stuff out. Like, ‘Oh, I messed up and started using again.’ ”
Maryann says that talking to a provider from home makes her feel “more comfortable and relaxed” than if she were visiting a clinic, and she’s been pleasantly surprised by the compassion of her providers.
“I’ve been to doctors before who were really mean and judgmental,” she says. “But they’ve been just the opposite. Even over the phone you can tell they have open hearts and really want to help you.”