Here are some of my source documents
- Pandemic prevalence of mental health symptoms and substance use (CDC)
- Increase in overdoses (New York Times)
- Suicides and overdoses among the young (Robert Redfield, M.D. [CDC])
- Business cycle and suicide (Am J Public Health 2011;101:1139)
- Dangerous, counterfeit pills in Minnesota (DEA)
Methadone, the first evidence-based treatment for opioid addiction, appeared way back in 1965. In the years that followed, “methadone clinics” popped up in large cities that could financially support them. But most patients—especially those in greater Minnesota—were unable to access this potentially life-saving care.
The U.S. Food & Drug Administration attempted to remedy this health disparity by approving Suboxone in October 2002. The hope was that family physicians, internists and psychiatrists would prescribe it in their clinics, thereby creating broad access to addiction care.
Unfortunately, that idea was very slow to take off. Rural providers cited a range of barriers—time, risk, lack of ancillary mental health services—as reasons for not prescribing. As a result, Suboxone tends to be available through addiction medicine specialists (like me) who practice in large cities and are subject to federally-imposed patient limits.
About a year ago, Allina Health decided to take a different tack. We came up with a simple access strategy:
- Addiction medicine specialists treat patients for opioid addiction via telehealth
- Specialists transfer care to local primary care providers once patients are stable
- Primary care providers can always consult with addiction medicine specialists or return patients to us if there are struggles
The first provision addresses primary care providers’ concerns about treating active substance abusers. The second feature ensures that addiction medicine specialists always have capacity for new patients. The last design feature is how primary care interacts with every other medical specialty—cardiology, nephrology, endocrinology—when it comes to chronic disease management.
And it worked!
Our pilot program at New Ulm Medical Center, a critical access hospital, was a resounding success. We’re presently working to scale it to Allina’s entire service area. We’re also launching virtual visits next week, which will allow patients to be seen via their own smartphone or tablet.
All of this was a heavy lift by a committed team:
- Joe Clubb and Paul Goering, M.D., executive sponsors
- R. John Sutherland, Ph.D., my dyad partner
- Barb Andreasen and Paula Maidl, project managers
- Carl Scales, IT wizardry
- Laura Moldan, Claire Olson, Jamie Penkert and Mindy Eichstadt; nursing staff at New Ulm Medical Center
The addiction medicine specialists are still located in a large city many hours from patients but distance is no longer a barrier to receiving care. ✸
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Postscript. I received a good question about the Ryan Haight Act. Our program is exempt from the in-person medical evaluation requirement as New Ulm Medical Center is a DEA-registered hospital. Please consult your compliance department or personal attorney about your particular clinical circumstances.
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Postscript. We launched virtual visits today (February 24th) as planned. The first patient lives near the Iowa border, two hours from both New Ulm Medical Center and the Twin Cities. The virtual visit saved him roughly four hours of driving for a 30 minute visit.