BINGHAMTON, NY (WSKG) — Around seven out of every 10 community health center visits are happening remotely, according to a recent survey from the Community Health Care Association of New York.
Bottles of the generic prescription pain medication buprenorphine, used as an alternative to methadone to help people with opioid use disorders manage cravings. (Joe Raedle/Getty Images)
Telehealth and telemedicine eliminate some of the barriers rural residents in the Southern Tier face when accessing health care, such as travel and transportation. They can be especially helpful for those with chronic health issues that require frequent appointments, like opioid use disorders.
Alicia – who requested WSKG only use her first name to protect her children – meets with her doctor over Zoom every two weeks. She began medication-assisted treatment for an opioid use disorder in March 2020.
Alicia spent months trying to find a doctor near her home in Chenango County who could prescribe her Suboxone, a common brand-name for buprenorphine. It’s a prescription drug used to treat opioid use disorders by reducing symptoms of withdrawal and cravings.
“I called every clinic and every provider in Chenango, Delaware and Otsego Counties trying to get into a clinic to get onto Suboxone and [each time] it was a six-month wait,” Alicia said.
According to Pew Charitable Trusts, 88 percent of large rural counties in the U.S. lack a sufficient number of opioid treatment programs. Those who can prescribe medications are then overloaded with patients and long waiting lists, similar to what Alicia encountered in the Southern Tier.
Instead, she found a provider in Waverly, in Tioga County—more than an hour’s drive away. Alicia gets anxious about driving on highways, so her boyfriend would drive her to and from in-person appointments.
After just three visits, however, the state went on lockdown. Like much of everything else, her appointments went online. While many aspects of life became harder, the switch to telemedicine made that part of her routine less complicated.
“It’s so much easier to just have a 45-minute phone call and then be on with my day,” Alicia said.
The benefits of telemedicine for people in medication-assisted treatment for opioid use may also be more effective. A 2017 study of patients in Ontario, Canada found those receiving treatment over video-conferencing had higher rates of retention than patients who met their doctor in person.
Denine Polen, a nurse practitioner and Suboxone prescriber in Delaware County, said speaking to patients virtually from their homes can also reduce stigma.
“It allows them to not only open up but it’s not punitive,” Polen said.
These days, Alicia logs on to Zoom sessions with her doctor from her car in the parking lot outside of work. Still, like many who use Zoom know, doing so can come with technical difficulties.
“The one day I was working at a different store than my regular store and I had spotty service, and it kept disconnecting and reconnecting,” Alicia recalled. “So half of my appointment was like, ‘Hello, can you hear me? Can you hear me?’”
Still, it means Alicia doesn’t have to miss work and she can stay closer to her three daughters. They are the reason, she said, that she’s been actively seeking recovery for almost two years.
Prior to that, she overdosed after taking too many Percocet. Alicia said she always knew what her opioid use could lead to; she lost two brothers to overdoses years before she began using.
“I never thought that I was at that point that it would lead to that,” Alicia said. “And one day I took too many, and next thing you know I woke up on my kitchen floor with my boyfriend standing over me crying. It was the scariest moment of my life, and that’s when I decided I got to stop, I got to do something.”
In the moments after her boyfriend revived her with Narcan, she decided she was ready for recovery.
“I want to raise my kids,” Alicia remembers thinking in that moment. “I don’t want to die.”
Alicia said she misses meeting for in-person appointments. They feel more personal and allow her to read her doctor’s body language. Prior to the pandemic, her doctor only scheduled monthly appointments, but now that it is all through Zoom, they are every two weeks.
“I feel like that keeps me on track more, because I get that therapy as well the talk-therapy,” Alicia said. “Sometimes you just need a reminder, a kick in the butt.”
Telemedicine may help residents from rural areas more conveniently access medication-assisted treatment, but it does not solve the shortage of Suboxone prescribers in the Southern Tier.
John Barry outside of STAP offices in 2019. (Sarah Gager/WSKG Public Media)
John Barry, executive director of the Southern Tier AIDS Program (STAP), said the region has few doctors willing to prescribe medications like Suboxone and not enough treatment programs that offer them.
“Even though they’re one of the few things that we can prove stops people from dying,” Barry said. “We cannot prove that with traditional treatment where you sit around and do 12-step based stuff from the 1930s.”
The pandemic has not slowed down the nation’s opioid overdose epidemic. The CDC reported an increase in the number of fatal opioid overdoses before and during the pandemic. A separate study of emergency room visits from December 2018 to October 2020 published earlier this month found that overdoses increased by nearly 30 percent in 2020. Advocates and researchers both say that increased isolation and stress may be a leading cause.
“Our folks are more isolated, so they’re not able to go out, not able to talk to people, not able to see people face to face, and that’s really tough for people,” said Emily England, who oversees Prevention Point, a syringe exchange program in Broome County, and harm reduction services for STAP.
England said isolation can increase a person’s risk of fatal overdose. Harm reductionists typically encourage people who use substances to use with another person, that way someone is there to call 911 or administer Narcan if necessary.
Polen, in Delaware County, said increasing access to medicated treatment may be a step in addressing the overdose epidemic.
“If we can make it easy instead of more difficult, we might be able to address what’s happening with the overdose rate,” she said.
England said she does see evidence of telemedicine’s success with Prevention Point’s participants. In the past, many of them would miss their care appointments because of logistical barriers similar to what Alicia experienced, like long distances and a lack of transportation.
With fewer obstacles in their way, they may have a chance at more successful treatment.
“People have been able to attend all of their appointments and really engage, and not have to worry about those other barriers that are in the way for them,” England said.
Additional reporting by Sarah Gager.