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Live via video feed: Doctors treating addicts


The next big thing in drug treatment: Telemedicine.

Among the topics that kicked off the annual meeting of the Addiction Industry Executive Summit in Naples last week was using the internet to remotely treat recovering addicts.

Telemedicine allows doctors and therapists to communicate with patients via live video — similar to Skype or Facetime. According to the American Medical Association, four of five office visits could be handled without a trip to see the doctor.

Telemedicine is already used to treat common illnesses such as bronchitis, pink eye and urinary tract infections.

But can — and should — it be used for treating addiction? Using telemedicine to treat drug addicts provides unique obstacles for patients, treatment providers and insurance companies.

Telemedicine will allow recovering addicts who live in rural areas, who have no transportation or have child-care issues to interact with their treatment team. On the flip side, addicts won’t be able to use their remote location, lack of transportation or child care as excuses to avoid seeing their treatment providers.

Because psychiatrists and addiction specialists are in such short supply and must be licensed to prescribe buprenorphine — a drug used to wean addicts off opioids — telemedicine could enable more addicts to be treated with buprenorphine.

However, doctors and therapists won’t be able to get a true picture of their patient’s condition without costly video equipment that captures more than just the face of an addict, who may attempt to disguise a relapse.

“I have seen people trying to do it on laptop or itty-bitty webcam,” said Dr. Corey Waller, senior medical director for education and policy at the Camden Coalition for Healthcare Providers in New Jersey. “If I can’t see a patient, I can’t see what’s going on. He could be flipping me off under the table.”

Waller, a keynote speaker at the conference, estimates the cost of a video and audio system that can provide effective and safe treatment at $10,000.

The biggest hurdle is not the cost but licensing requirements. Some states require physicians practicing telemedicine to be licensed in the state where their patient lives. That means a doctor licensed in Florida would not be able to treat a patient via telemedicine in those states without an additional license.

Besides the hardware and licensing, practicing telemedicine requires enhanced security to comply with federal privacy laws. Common live stream platforms, such as Skype, are not secure.

Lisa Merconchini, a Boca Raton clinical psychologist created a secure, web-based telemedicine platform. Her company, Premier Telehealth, uses copyrighted, encrypted software to protect patients’s privacy. Merconchini was the only vendor at the conference offering a telemedicine treatment platform.

Merconchini sees telemedicine as particularly valuable for addicts after they leave residential treatment programs and return to their home and jobs.

“I think typically when they leave treatment they fall out of aftercare,” Merconchini said. “This allows them to stay engaged and follow aftercare.”

Without telemedicine, addicts often must find a new treatment team when they leave rehab. Beyond what is in their medical records, new doctors and therapists know little about the addict.

Telemedicine enables addicts to continue working with the same doctors and therapists. Because they have had face-to-face interaction with an addict from early recovery, they are more likely to identify warning signs of a relapse, Merconchini said.

“You already have an established rapport,” Merconchini said. “Because you have had that in-person care, you are familiar with non-verbal cues.”

Florida is among a handful of states that has no laws governing how telemedicine can be practiced. In 2016, lawmakers passed a bill that established a Telehealth Advisory Council within the Agency for Health Care Administration to begin looking at how telemedicine should be practiced in Florida.

No legislation about telemedicine has been filed for the legislative session that begins in March.

As of May 2015, 24 states and the District of Columbia have mandated that private insurance plans reimburse for telemedicine at rates equal to an in-person consultation. Forty-eight state Medicaid programs also reimburse for some form of telemedicine via live video.

The question now is, will drug treatment providers use it?

Some say they would not be comfortable using it in early recovery. However, it could be a valuable tool for follow-up care and therapy after an addict leaves treatment and goes home. It also provides a continuity of care, so the addict does not need to find new doctors and therapists back home.

Origins Behavioral Healthcare on 45th Street in West Palm Beach uses telemedicine but not to treat addicts, said Origins CEO Drew Rothermel. Instead, Origins uses telemedicine to enable its own doctors to conference in real time across its locations in Florida and Texas.

“There is a vested interest for Florida to have as robust telemedicine as possible,” Rothermel said. “So much of Florida treatment is medical tourism.”



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