At the Crossroads of Crisis: Opportunities to revolutionize substance use disorders care

A public health crisis of global scale has stalled economies, killed hundreds of thousands and disrupted daily life all over the world.

However, the current coronavirus pandemic is not the only public health threat challenging us. Now buried under the headlines is the insidious opioid epidemic which has also killed thousands, cost millions, and shows little sign of abating.

In New Hampshire, a state with some of the highest per-capita overdose deaths in the U.S., deaths from drug overdoses actually dropped between 2018 and 2019, marking the first significant decline since the onset of the opioid epidemic. Treatment and recovery access has undergone an impressive period of expansion, with a six-fold increase in treatment access in New Hampshire, largely attributed to expanded reimbursement for Substance Use Disorders (SUD) in public and private insurance. Recovery centers are providing real connections and support as people navigate the lifelong journey into recovery. Communities, schools, and the healthcare system have stepped up to expand early screening, and adopt proven strategies to reduce the risk of youth developing substance use disorders later in the life.

Then came the pandemic and unfolding economic consequences, which have up-ended daily life. These developments are going to challenge the gains made in behavioral healthcare over the past decade. Widespread unemployment, social isolation and the toxic stress and trauma created by loss of life, economic vitality and mobility stand to serve as an accelerant to drive more American citizens into the throes of behavioral health challenges. The impact on communities and our health care system will be felt for years to come. While it will be some time before we can  assess the full impact of the pandemic on our nation’s behavioral health, emergency actions taken to date have actually opened opportunities to revolutionize behavioral healthcare in ways that make now a time when additional investments could bring about widespread and lasting change for the better. One of the earliest moves at the federal level was to require public and private insurance to cover the cost of delivering behavioral healthcare remotely, through telehealth technologies and strategies. This is the first time technology-based solutions to behavioral healthcare have been given a payment model that allows for scale.

It should be noted that online or phone-based treatment and recovery supports are not a panacea. Treatment and recovery require individuals to reconnect with community and foster new relationships, some of which can’t be fully realized on a screen. However, given transportation and other barriers to accessing care, the ability to expand the toolbox to include more computer and phone-based supports could be a game-changer. And while the current allowance for these services is based on the pandemic emergency, already advocates are calling for expanded telehealth to be sustained after the pandemic ends.

Recovery centers are providing real connections and support as people navigate the lifelong journey into recovery. Communities, schools, and the healthcare system have stepped up to expand early screening, and adopt proven strategies to reduce the risk of youth developing substance use disorders later in the life.

There are several ways that investors can engage now to ensure the long-term viability of telehealth services for substance use disorders. Each brings the option of expanding care and impact not only today, but well into the future as we navigate a likely increase in demand for care.

Though policies now allow for telehealth services, most healthcare providers and nonprofit social service agencies lack the necessary equipment to provide such care. At the New Hampshire Charitable Foundation, we have moved in the past four weeks more than $300,000 in grants to nonprofit organizations to purchase necessary computers, software and phones for their staff, as well as for clients, who may not have access to their own technology or wifi. We are monitoring federal stimulus funding– some of which is designed for telehealth services – to make sure local organizations have the capacity to pursue those funding sources to further expand their capacity.

In addition to hardware, this expansion won’t succeed without significant investment and scaling of software solutions. While a smattering of platforms exist in the marketplace, many have either not achieved critical scale, or lack privacy protections or data-sharing protocols required under existing privacy regulations, including HIPPAA and 42 CFR Part 2. These regulations include very stringent requirements around the sharing of health information for those with a diagnosed Substance Use Disorder – and in many instances, those protections are above and beyond patient data protections for other diseases. Though the current emergency order waives some of those requirements, long-term solutions will only be viable if they have built-in protections for patient data and privacy – and seamless data-sharing interface on the back end of the providers caring for patients.

Lastly, investors in healthcare need to insist that, going forward, technology solutions for the healthcare system have behavioral health as a native component of their service array. For decades, the United States treated addiction as a moral failing or choice, and not as a disease. Addiction treatment was seen as “outside” of traditional healthcare – and this disconnect was a driving force in the explosion of our current opioid epidemic. Racial injustice furthered this divide, with minority communities disproportionately impacted by compounding factors of addiction and lack of healthcare access. Healthcare “solutions” that do not take into account behavioral health and social equity are not solutions at all. Investors can help ensure that we finally end such discrimination in our healthcare system, and ensure that those struggling with Substance Use Disorder are afforded the same robust healthcare response as individuals facing cancer, diabetes – or yes, coronavirus.