Ali Safawi: To beat opioids, you have to work it

Thursday, November 1, 2018 - 5:22pm

The opioid epidemic (or crisis, if you enjoy the dramatic) is a hot topic these days. Per the National Institute on Drug Abuse, between 21 and 29 percent of people who are prescribed opioids for chronic pain misuse them and between 8 and 12 percent develop an addiction.

The American Psychiatric Association defines addiction as a complex brain disorder that manifests as an intense focus on using a substance (e.g. drugs or alcohol) despite the harmful consequences. Drug addiction can take over people’s lives. It rewires the brain to cause intense cravings for the substance that make the prospects of a person stopping cold turkey unlikely.

Like with treating most chronic health conditions, treating addiction takes time. There’s no 21-day course of medication leaving you cured afterward, as with many infections. While in-patient rehabilitation — where patients are evaluated, go through medically-supervised detox and are then usually offered a variety of behavioral therapies all within a facility — is the most well-known form of addiction treatment, it is by no means the only one. For opioids, a treatment option growing in popularity is medication-assisted treatment. In MAT, a patient’s treatment combines behavioral therapies with medication that helps with both detox and with combating cravings on the way to recovery.

Much of what I know about opioids and MAT comes from my summer internship at Workit Health, a startup in Ann Arbor. Workit is on the cutting edge of addiction treatment, both for opioids and other forms, leveraging technology and the latest evidence-based treatments to provide addiction treatment that are both effective and accessible.

Workit Health, which operates in both Michigan and California, was founded by two women whom I deeply admire, Robin McIntosh and Lisa McLaughlin. I spoke with McLaughlin about the beginnings of Workit and the idea that spawned it.

“Robin and I met in 2009 and we were friends in the recovery community in the Bay Area,” McLaughlin recounts. “And in 2014 a close friend of mine from Michigan died — someone I had gotten sober with and had lived with when I was in graduate school — of an overdose, and it was a perfect timing with Robin to start something. So we decided to join forces and start the company, we both had experienced a lot of loss and it was a good way for us to redefine recovery.”

One of the unique things about Workit is its adherence to the idea of patients as designers — addiction treatment designed by people who are themselves in recovery.

Workit Health’s flagship program, Workit Clinic, combines telehealth, online health care, with Suboxone, a medication used to help addicts get off of heroin or painkillers. Because buprenorphine, the main ingredient in Suboxone, is a controlled substance, patients have to visit one of Workit’s brick-and-mortar locations in Ann Arbor or Lafayette, Calif. once to be prescribed Suboxone by a clinician with a federal waiver before continuing care online.

Current academic literature supports buprenorphine as effective at both reducing opioid use and keeping people in treatment, however, biases in the addiction recovery community persist. “One of the key challenges is that people who need to take medication for mental health conditions, be it for anxiety and depression or medication-assisted treatment, are not always accepted in recovery communities,” McLaughlin explains. She furthermore explains that there is a fear among some in the recovery community that using buprenorphine, which is itself an opioid, is just replacing one drug with another.

Unlike in-patient rehab and MAT with methadone, which requires daily trips to a federally-approved clinic for the medication, treatment with Suboxone can better fit into people’s busy lives. I also reached out to Brooke Houser, Workit’s interim head of Counseling, who said that the access Workit provides is a major draw for patients. In an email, Houser said that her typical patient wants to recover from addiction but has not been able to access care. Many of her patients, she says, live busy lives with children and jobs. They also may have tried other forms of addiction treatment without success.

Besides the initial clinic for an evaluation and Suboxone prescription, Workit Health is 100 percent online. Patients have appointments with their medical provider, chat with their dedicated peer recovery coach and attend support groups all from their computer. Each patient is also provided a personalized curriculum of online exercises — based on the latest behavioral health research — to help them through recovery.

Houser also echoed McLaughlin’s concerns about the limiting focus on traditional methods of sobriety. “Many institutions have not yet caught on to the proven, life-saving effects of medication-assisted treatment,” she wrote.

Both McLaughlin and Houser cited rural communities, like those in Michigan’s Upper Peninsula, as areas where Workit Health is well-suited to help. “Workit Health's online approach makes care available and convenient to even those who live hours from the office,” Houser says. And while the federal Ryan Haight Act prevents Workit’s clinicians from prescribing Suboxone without having the patient come to the Ann Arbor clinic, McLaughlin expressed hope that this and other public policy barriers would be removed by 2020. A hope, it seems, that Congress may be willing to deliver on.

Towards the end of our conversation, McLaughlin indicated what the future holds for Workit Health. Major private insurers in Michigan and California have begun to cover the treatment they provide and they have plans to expand into six new states in 2019.

To solve a complex problem like the opioid epidemic, we need to untether ourselves from old dogmas and embrace cutting-edge innovations. Workit Health, focused on improving access to treatment through technology and advancing methods with the science behind them, offers a model for such innovative solutions.

 

Ali Safawi can be reached at asafawi@umich.edu.

 

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