On October 16th, 2017, former President Trump declared the opioid epidemic a national public health emergency.1 During the 2017-2018 fiscal year, government funding directed towards opioid use disorder (OUD) treatment and recovery alone grew by $1.5 billion.2 Yet despite various efforts to quell this epidemic, such as limiting opioid prescriptions, the number of overdose deaths is still steadily increasing.3 Data from the CDC’s National Vital Statistics System reports that as of May 2022, the number of overdose deaths resulting from fentanyl and other synthetic opioids was over 71,000, a 23% increase from the year before and over a 300% increase from 21,088 deaths in 2010.4
Despite these disheartening results, effective treatments for opioid use disorder do exist. Methadone and buprenorphine are two medications typically prescribed to patients in medication-assisted treatment (MAT) for opioid abuse.5 As opioid agonists, these drugs have been shown in studies to significantly reduce the risk of overdose and opioid dependency in replacement therapy.6 However, the prescription of these life-altering drugs had been severely restricted due to the risk of drug abuse. Buprenorphine can only be prescribed by providers who have completed specific training programs and have received a waiver from the Drug Enforcement Administration (DEA) as per the Drug Addiction Act of 2000 (DATA).7 Prescription eligibility has been expanded by the Comprehensive Addiction and Recovery Act (CARA) of 2016, allowing nurse practitioners and physician assistants to prescribe buprenorphine after completing training, yet the deliverance of methadone remains limited only in federally licensed “methadone clinics”, severely hindering access to patients living in rural or remote areas.8,9,10
Not only that, restrictive take-home dose policies make it such that patients have to commute to clinics daily to receive their medication, making it difficult to maintain stable schedules at work or school.11 This physical binding of recovering patients in proximity to clinics as well as the psychological impression of being “restrained” from re-integrating into the outside world causes great anxiety and resentment among patients, who describe the existing MAT policies as a pair of “liquid handcuffs”.12 Together, these barriers to access have been theorized to contribute to reduced treatment retention as well as patient motivation to recovery, resulting in a relapse into drug dependence.13
The onset of COVID-19 worsened the opioid epidemic, yet also provided many insights for reform.14 The use of telemedicine greatly increased throughout the pandemic due to the lack of access to physical offices.15 In addition, restrictions previously requiring in-person consultations to authorize induction or continuation of buprenorphine were lifted.16 The Substance Abuse and Mental Health Services Administration (SAMHSA) also authorized physicians to provide up to 28 days' worth of dosages for patients to take at home.17 In conjunction, these policies allowed patients who may have been turned away from treatment due to logistical or geographic reasons to remain in therapy. In a retrospective study comparing OUD patients who utilized telemedicine during COVID to a control population that used regular clinic-based treatment before COVID, researchers at Drexel University found that the historical control had an average treatment retention of 22.5 days, while patients utilizing telemedicine during COVID had an average retention time of 180 days.18 The success of telemedicine combined with relaxed prescription policy suggests the key to recovery is increased access and flexibility to care, which can encourage continued patient participation in recovery programs.
In addition to telehealth, private companies are also seeking to develop mobile and text-based interventions to keep patients on buprenorphine. reSET-O, a 12-week software application program developed by Pear Therapeutics, accomplishes this by providing online cognitive behavioral therapy.19 This includes education modules regarding recovery, reminders for buprenorphine intake, as well as logging of triggers and cravings. An interactive physician view also provides an opportunity for providers to custom design modules according to the needs of the patient, allowing for greater flexibility in treatment routines. The application is the first of its kind to receive FDA approval in 2018 as a prescription digital therapeutic (PDT). However, efficacy analysis of reSET-O using limited data has not shown significant improvements in retention among participants, suggesting that much work still needs to be done to further refine PDTs in opioid recovery.20
Treatment for opioid use disorder has come a long way since its emergence, and so have attitudes toward substance abuse as a whole. From the hardline prohibitive policies during the “War on Drugs” and D.A.R.E, opioid abuse prevention, and recovery have become more methodical, personalized, and empathetic. As innovations continue to explore the capabilities of digital health in recovery, researchers and policymakers alike must strive to work together to develop patient-centered, evidence-based solutions to combat the opioid epidemic.
- Merica, D. (2017, October 16). Trump to declare national emergency on opioids months after initial promise | CNN politics. CNN. Retrieved September 4, 2022, from https://www.cnn.com/2017/10/16/politics/donald-trump-opioids-national-emergency
- Tracking federal funding to combat the opioid crisis. Bipartisan Policy Center. (2019, March). Retrieved September 4, 2022, from https://bipartisanpolicy.org/download/?x87411&file=/wp-content/uploads/2019/03/Tracking-Federal-Funding-to-Combat-the-Opioid-Crisis.pdf
- Centers for Disease Control and Prevention. (2021, November 10). U.S. opioid dispensing rate maps. Centers for Disease Control and Prevention. Retrieved September 4, 2022, from https://www.cdc.gov/drugoverdose/rxrate-maps/index.html
- Stobbe, M. (2022, May 11). US overdose deaths hit record 107,000 last year, CDC says. AP NEWS. Retrieved September 4, 2022, from https://apnews.com/article/overdose-deaths-opioids-fentanyl-8cb302a70ddbb6a435f9e8fbb19f153b
- Medications for Opioid Use Disorder For Healthcare and Addiction Professionals, Policymakers, Patients, and Families . Substance Abuse and Mental Health Services Administration. (2021). Retrieved September 4, 2022, from https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP21-02-01-002.pdf
- NIDA. 2021, December 3. How effective are medications to treat opioid use disorder?. Retrieved from https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/efficacy-medications-opioid-use-disorder on 2022, September 4
- Buprenorphine for the treatment of Opioid Use Disorders. (2017). Retrieved September 4, 2022, from https://www.ihs.gov/sites/opioids/themes/responsive2017/display_objects/documents/buprenorphineprescribingppolicy.pdf
- S.524 - Comprehensive Addiction and Recovery Act of 2016. Congress.gov. (2016, July 22). Retrieved September 4, 2022, from https://www.congress.gov/bill/114th-congress/senate-bill/524
- Methadone. SAMHSA. (2022, June 23). Retrieved September 4, 2022, from https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/methadone
- Andrilla CHA, Coulthard C, Larson EH. Barriers Rural Physicians Face Prescribing Buprenorphine for Opioid Use Disorder. Ann Fam Med. 2017 Jul;15(4):359-362. doi: 10.1370/afm.2099. PMID: 28694273; PMCID: PMC5505456.
- Buprenorphine Quick Start Guide - SAMHSA. SAMHSA. (n.d.). Retrieved September 4, 2022, from https://www.samhsa.gov/sites/default/files/quick-start-guide.pdf
- Frank, D., Mateu-Gelabert, P., Perlman, D.C. et al. “It’s like ‘liquid handcuffs”: The effects of take-home dosing policies on Methadone Maintenance Treatment (MMT) patients’ lives. Harm Reduct J 18, 88 (2021).https://doi.org/10.1186/s12954-021-00535-y
- The Pew Charitable Trusts. (2021, May 24). Policies should promote access to buprenorphine for opioid use disorder. The Pew Charitable Trusts. Retrieved September 4, 2022, from https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/05/policies-should-promote-access-to-buprenorphine-for-opioid-use-disorder
- The opioid epidemic got worse during the pandemic. A $3.15 billion program addresses the addiction crisis. The opioid epidemic got worse during the pandemic. A $3.15 billion program addresses the addiction crisis. | Pandemic Oversight. (2022, May 5). Retrieved September 4, 2022, from https://www.pandemicoversight.gov/data-interactive-tools/data-stories/opioid-epidemic-got-worse-during-pandemic-a-315-billion-program#:~:text=during%20the%20pandemic.-,A%20%243.15%20billion%20program%20addresses%20the%20addiction%20crisis.,were%20the%20result%20of%20opioids.
- Demeke HB, Merali S, Marks S, et al. Trends in Use of Telehealth Among Health Centers During the COVID-19 Pandemic — United States, June 26–November 6, 2020. MMWR Morb Mortal Wkly Rep 2021;70:240–244. DOI: http://dx.doi.org/10.15585/mmwr.mm7007a3
- Telehealth tip sheet - providers clinical support system. Providers Clinical Support System. (2020, May). Retrieved September 4, 2022, from https://pcssnow.org/wp-content/uploads/2020/05/Telehealth-Tip-Sheet.pdf
- Opioid Treatment Program (OTP) Guidance. Substance Abuse and Mental Health Administration. (2020, March 19). Retrieved September 4, 2022, from https://www.samhsa.gov/sites/default/files/otp-guidance-20200316.pdf
- Kathleen M. Ward, Ayden Scheim, Jonathan Wang, Benjamin Cocchiaro, Katie Singley, Alexis M. Roth, Impact of reduced restrictions on buprenorphine prescribing during COVID-19 among patients in a community-based treatment program, Drug and Alcohol Dependence Reports, Volume 3, 2022, 100055, ISSN 2772-7246, https://doi.org/10.1016/j.dadr.2022.100055.
- Reset® & Reset-O®. Pear Therapeutics (US). (2022, September 1). Retrieved September 4, 2022, from https://peartherapeutics.com/products/reset-reset-o/
- Sandoz and pear therapeutics announce us launch of Reset-OTM to help treat opioid use disorder. Novartis. (2019, January 7). Retrieved September 4, 2022, from https://www.novartis.com/news/media-releases/sandoz-and-pear-therapeutics-announce-us-launch-reset-otm-help-treat-opioid-use-disorder