Telehealth-based opioid treatment (TBOT) may have just recently gained traction during the pandemic, but it’s here to stay. Still, a lot of people have questions about whether telemedicine treatment falls short of in–person care. The answer to that is an emphatic no. New peer-reviewed research with over 3,000 patients just published by Ophelia in JAMA Health Forum, one of the world's top health-policy journals, adds further evidence backing the validity of TBOT.
Ophelia researchers studied whether routine urine drug testing can be adapted to TBOT platforms for the treatment of opioid use disorder. Drug tests are one of several tools that we have to help patients meet their treatment goals, and there is an urgent need for rigorous studies exploring whether they can be adapted to a remote-care setting.
Findings showed that urine drug testing was “highly feasible and sustained throughout the duration of treatment, consistent with in-person settings.” Additionally, rates of “unexpected results'' were low throughout care. Translation: Substances that should have been detected in patients’ urine (like Suboxone) were in there, and non-prescribed or recreational drugs were, overwhelmingly, not.
“We’ve proven the acceptability and feasibility of drug testing in a remote care environment”
says Arthur Robin Williams MD MBE, Ophelia’s Chief Medical Officer and an addiction psychiatrist and assistant professor at Columbia University, who led the study.
“Historically drug testing has been used in really punitive ways that are not patient-centered, and it’s also been riddled with discriminatory and racist practices,” says Williams. “Luckily clinicians have largely evolved, especially with newer generations, and are much more interested in patient-centered approaches to care.” What this means is that urine drug screenings are a tool, but how individual patients and clinicians use it at Ophelia has some flexibility. Most importantly, “we've never kicked a patient out because they have a drug test result that shows they’re using opioids — or anything else.”
Read the peer-reviewed study here. And find a few key takeaways below:
1. Nearly 100% of patients had a drug test result that was positive for buprenorphine in the first month after they started their induction. What this shows is not only that you can do urine testing in the remote care environment, but also that there was a near-perfect rate of getting all Ophelia patients to have a urine test after their induction. And virtually all of those urine samples were buprenorphine-positive. Specifically: 83.3% of patients completed a urine drug test within 30 days (some patients may have dropped out of care early). 97.6% patients retained 90+ days completed one or more urine drug tests, as did 99.7% of patients retained 180+ days.
2. Quality checks help ensure that remote drug testing is reliable. After a patient starts their buprenorphine induction, usually by the second visit, they take a urine sample. The process begins when they’re face-to-face with a clinician over video chat, meaning that they don’t peel the label off the dip cup until the Zoom visit begins. This, plus sophisticated tools that test for adulterants (for example temperature strips and creatinine checks), creates a process that matches an in-person laboratory’s capability to detect a specimen that isn’t legitimate.
3. Urine drug testing can be done regularly, even in the remote setting. Ophelia research showed that the average number of drug tests completed during a patient’s first six months of treatment is around three and a half drug tests. This means that patients can use it for accountability over time.
4. By leveraging real-world data, we tapped into the experience of thousands of patients. In contrast to clinical trials which usually have narrow, predefined patient criteria (and therefore may have a limited patient sample), real-world evidence helps us understand the true utilization of at-home urine drug testing, making this a groundbreaking study. Real patients — 3,395 of them, to be exact — showed us what a small sample in a clinical trial never could.
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