Not only does Lisa McLaughlin see the now-waived requirement of an initial face-to-face patient visit for initiating buprenorphine as not medically necessary, she considers it damaging for some patients' prospects for getting into recovery. At the virtual Rx Drug Abuse & Heroin Summit last week, the co-founder of Workit Health described removing transportation barriers as one benefit to her organization's effort to prescribe buprenorphine through telemedicine.
Rather than force residents of Michigan's Upper Peninsula, for example, to drive hours to Workit Health's Ann Arbor clinic location as they try to detox from heroin, McLaughlin said her organization seeks to “grab an individual in moments of willingness and never let them go.”
Workit Health now is serving 17 million covered lives in five states. It takes a medication-first approach to treating opioid use disorder (OUD) but also incorporates a recovery curriculum offering a number of behavioral therapies, via one-on-one and group sessions conducted virtually. Patients also participate in weekly video appointments with their doctor or nurse.
McLaughlin considers retention in treatment to be Workit Health's primary measure for success, likening the program to a “Planet Fitness” model in which participants get out what they put in. Having tracked outcomes for 479 participants in Michigan and California, the organization reports that two-thirds of patients remain in the program longer than six months.
Patients also develop trust in the professionals with whom they work, McLaughlin explained: Workit Health has found that patient self-reporting of drug use matches the results of drug tests 90% of the time. She explained that drug testing in the program is used mainly as an engagement tool rather than a compliance mechanism.
Shaped by personal experience
The past experiences of McLaughlin and her co-founder as women in recovery played a major role in how they wanted to design their program. They were well aware that many individuals in need of treatment are more likely to engage through virtual contact at the outset. Scheduling therefore takes place virtually.
“They are looking for any way to reach us that does not involve calling,” McLaughlin said. It's their way of taking a “toe dip” into recovery.
Other barriers to attending face-to-face therapy or recovery groups include the potential that the patient might run into someone from their work life, and that is seen as possibly having a detrimental effect on their career, McLaughlin said.
The need for accessible medication treatment for OUD in Michigan was great, she said, with less than one-third of the state's substance use treatment facilities offering any medication treatment. “We started the organization because the status quo was not working,” McLaughlin said.