The scope of the opioid addiction crisis in the U.S. has forced our health care industry to take a much closer look at how we manage the disease of addiction. In 2016, drug overdoses killed roughly 64,000 people in the U.S. with overdose deaths from fentanyl increasing 88% every year between 2013 and 2016.
The reach of the opioid epidemic has been far and wide, and undiscriminating. With such large communities being impacted, digital health has shown great promise as a tool to effectively manage the disease of addiction, especially for at-risk populations with unique needs.
A lack of support for those most at-risk
A story in the Boston Globe reported that in Massachusetts, “nearly four in 10 deaths among women who gave birth between 2011 and 2015 were caused by opioid overdoses, compared with two in 10 among women who did not give birth.” New mothers who struggle with addiction receive very little support, and sadly, this isn’t a problem unique to Massachusetts but common across the U.S.
Being a new mother often comes with a hefty set of challenges for women—learning how to care for an infant, sleep deprivation, postpartum depression, breastfeeding—however those challenges can be magnified for women recovering from opioid addiction, increasing the chances that they relapse or overdose.
There are many programs to help women sustain their sobriety while pregnant. According to the article, “With women motivated and supported, rates of overdose-related deaths drop during the second and third trimesters.” However, the narrative changes dramatically once the baby comes. The resources that supported women pregnant, drastically dwindle postpartum, and as a result, the overdose death rate soars among women six months to a year after giving birth.
“We take intensive care of women during pregnancy. Postpartum, we drop them like a hot potato,” said Daisy J. Goodman, a clinical assistant professor at the Dartmouth Institute for Health Policy and Clinical Practice.
Can digital health help fill the gap?
The Globe story reveals that in Massachusetts, 60 percent of mothers with opioid use disorder are homeless and 70 percent have a serious mental illness. Additionally, many have experienced trauma and postpartum depression. Certainly these factors aren’t unique to women in Massachusetts, so how can health care better support these mothers, and others, as they work to maintain their recovery under extraordinary challenges?
This is where digital health can be incredibly impactful by offering personalized, ongoing support to help patients struggling with addiction maintain their recovery. Programs that meet patients right where they are in their journey to recovery are critical.
Boston Medical Center offers programs that help women stop using drugs during pregnancy and that also support them after the baby arrives, realizing there is a significant lack of resources for women in recovery during this crucial time. The Center’s SOFAR (Supporting Our Families through Addiction and Recovery) clinic makes multiple specialists available to patients—pediatricians, internists, social workers, and psychotherapists—so that mother and baby can receive care on the same day, in the same location. In doing so, the clinic is also able to provide and coordinate care for a patient’s opioid addiction as well as any other condition that may require treatment.
A physician at Cambridge Health Alliance, Dr. Zev Schuman-Olivier, a psychiatrist and medical director for addictions, offers technology that provides remote treatment for addiction for postpartum women and others. Patients can meet with “mobile recovery coaches” daily by videoconference using their smartphones. Coaches are trained to work remotely counseling people with addiction. Patients can also have their medications automatically dispensed via a device using a code provided by their recovery coach. “While the coach watches, the patient dissolves the medication under her tongue.”
Technology can improve today’s model of addiction care
The opioid crisis has proven that our health care system needs to refine its approach as to how it addresses such a complicated chronic disease like addiction. Increasingly we’re seeing that technology has the power to dramatically improve that approach, to make it more viable and realistic for the patient.
Digital solutions, such as those offered by Cambridge Health Alliance, enable a high level of engagement to better support individuals living with this disease, helping patients to manage and sustain their recovery long term and through a variety of circumstances—such as becoming a new mother.
Digital health can also be a huge asset for patients in recovery outside of the major metropolitan areas, where access to care can be limited. Rural areas are highly underserved when it comes to health care resources. Even transportation options, like taxis and rideshares, are far less available, and commutes to the nearest health care facility can be lengthy, making regular appointments difficult to maintain.
For chronic diseases like addiction, that require ongoing support and consistent follow up, telemedicine tools like text messaging, email, and phone are hugely beneficial to support patients throughout their recovery journey. For example, Face IT TOGETHER– an organization committed to helping patients manage addiction- offers patients the option to communicate with a recovery coach using video chat, providing a more human connection even though the coaching is remote. It also enables face-to-face communication when the person needs it, at any time, from anywhere.
In addition to continuous coaching support, digital health technology helps patients by learning about their needs across populations, and then identifying their pain points to improve support. Like new mothers recovering from addiction or people living in rural or underserved areas, we can develop more flexible, patient-centered solutions, such as remote counseling and automated medications, that will actually foster real change for patients with complex needs.