RESEARCH ROUNDUP: October

Experts share mixed reviews of telemedicine for addiction treatment, report finds flaws in medically assisted recovery programs, much more

The coronavirus pandemic, a presidential election and much more continued to hang over all of us, this past month. 

In colleges and hospitals across Boston, meanwhile, addiction experts waded through that context to finish their own new and unique research on addiction. 

Read on to see a recap of the latest local reports, papers and studies reshaping and refining our collective understanding of this public health crisis. 

Telemedicine is good news for addiction treatment...But it also has its problems

A viewpoint column in the Journal of General Internal Medicine argued, last month, that the growth of telemedicine amid the COVID-19 pandemic removes some barriers to addiction treatment while introducing new ones. 

Penned by Mass. General Hospital doctors Sarah Wakeman and Mubeen Shakir, the article notes that massively proliferated telehealth programs can encourage treatment by simply making it easier to access. All the while, though, Shakir and Wakeman also say the combination of racism and disproportionate poverty among people with addictions somewhat mitigates those telehealth benefits. 

“The move to telemedicine presents an opportunity to positively impact the lives of patients with SUD,” the authors write. “But its implementation must be deliberate to not exacerbate the structural inequities that already plague the care of these patients.”

Before the pandemic, this paper notes, 13,000 Medicare patients got telemedicine per week. By late April, the number jumped to 2 million.

That explosion has brought changes to patients interacting with all facets of the medical industry. Many of those changes are for the better.

With telehealth, there’s no need for public transit or lengthy car commutes, this paper notes. Patients don’t need to take as much time off work. And they see their childcare burdens substantially minimized. 

For addiction patients, though, there’s also a fear that telehealth treatment will decrease the quality of care. Likewise, as many addiction patients face homelessness and/or extreme poverty, WIFI connectivity issues are common. Such situations limit any ability to get care by Zoom or other remote means.

What’s more, persistent regulations against remote prescribing of drugs like methadone have made it hard for patients wanting medications for opioid use disorder to actually get those badly needed drugs. 

There’s been some progress on that latter front, this paper notes. But it’s not nearly enough. 

As academics and front-line workers battling addiction every day have shared this new work around the country, Wakeman and Shakir’s paper immediately saw a local audience pick it up, offering boots on the ground implementations of its recommendations.

“The low threshold clinics I work for provide both in person and telehealth primary/SUDS care,” Boston doctor Dinah Applewhite tweeted while sharing the paper link. “In order to keep our patients accessing other necessary care…we try to provide our patients safe, private places with phones [for telehealth appointments].”

She concluded with a simple statement well in line with Wakeman and Shakir’s arguments on broader systemic failures. 

“Patients deserve better.”

Read Sarah Wakeman and Mubeen Shakir’s full paper... https://link.springer.com/article/10.1007/s11606-020-06299-8

Research uncovers poor retention in opioid medication programs 

A report earlier this month by Boston addiction expert Simeon Kimmel raised tough questions about the medical community’s ability to shepherd people facing opioid addictions into medically assisted recovery programs. 

Findings came within a larger look at whether medication assisted treatments for opioid use disorder reduced mortality for people with a specific heart infection caused by IV drug use. Together, this report revealed that poor retention of people who start recovery programs not only fails to reduce deaths due to infections, but also allows people to continue struggling unsupported in addictions.  

“This is discouraging,” Kimmel tweeted in an announcement of his work. “We need to do more.” 

Read Simon Kimmel’s complete report...https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2771450?resultClick=3

NOTE: The text of this summary was originally included in a weekly Substantive newsletter update published Nov. 4.

Report calls for revised breastfeeding guidelines for mothers with addictions

A report by a team of Boston Medical Center and Mass. General Hospital researchers, this month, called on medical professionals to develop more nuanced breastfeeding recommendations for women who use drugs during their pregnancies.

While science agrees that opioid use during pregnancy does increase the risk of both stillbirth and neonatal abstinence syndrome, this new report notes that drug use even during the third trimester of a pregnancy does not necessarily guarantee drug use after birth.

Though breastmilk can pass on drugs when a mother is actively using, advice against nursing for women with extended sobriety can also harm children, researchers say.

“[There is a] growing evidence base to challenge ways we differentially treat pregnant and breastfeeding people who use non-sanctioned substances,” MGH researcher Sarah Wakeman wrote in a Tweet announcing this new paper. “[It’s] outrageous that guidelines recommend against breastfeeding for third trimester [drug] use.”

Boston experts say the decision whether to breastfeed should be one parents and doctors should make collaboratively on the date a baby is born. 

If doctors want to utilize urine drug tests, this paper adds, that’s when they should take place, not weeks or months earlier.

Read the full report from the Journal of Addiction Medicine…

And see more extensive Substantive reporting on this research...https://substantive.substack.com/p/some-say-dont-breastfeed-after-prenatal

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A photo shows Mass General Hospital, where researchers worked together on multiple addiction related studies published this month. (Photo by Tom Austin, used under Creative Commons lisence)