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Addiction Fears Rise as Physicians Prescribe More Opioids for COVID-19 Survivors

Health experts claim that COVID-19 survivors are at risk for a potential second pandemic. Since physicians prescribe these patients a high rate of pain pills, going through a second pandemic of addiction to opioids is a very real possibility. Nature put out a new study that found COVID-19 survivors at Veterans Health Administration facilities had distressingly high rates of opioid use that came from helping them deal with lingering illness symptoms.


They found that around 10% of survivors went on to develop a condition known as long COVID. They began struggling with disabling health issues for six months or more after their initial diagnosis. For every 1,000 so-called long COVID patients doctors treated at these Veterans Affairs facilities, physicians wrote nine more opioid prescriptions than they normally would have. Additionally, they wrote 22 additional benzodiazepine prescriptions, including addictive pills to treat anxiety like Xanax.


Previous studies also found that COVID-19 long haulers or survivors experience a myriad of health problems that persist for months. The study’s lead author, Dr. Ziyad Al-Aly, found that these COVID-19 survivors are using more addictive prescription medications. Dr. Ziyad Al-Aly is very concerned that even a very small increase in people using addictive opioid medications can and will lead to the opioid crisis resurging due to the big number of COVID-19 long haulers. To date, more than three million of the 31 million survivors end up developing long-term symptoms. These symptoms can include depression, fatigue, anxiety, shortness of breath, and brain fog.


The study also found that several survivors also reported bone or muscle pain. The jump in prescribing opioid medications was surprising due to the very valid concerns about their risk for addiction. Dr. Al-Aly studied over 73,000 patients at Veterans Affairs facilities for his study. He said that the physicians are supposed to think twice about prescribing opioids for the pain.


Dr. Aly-Aly also believes that physicians need to act before it’s too late. The last thing we want is to have another opioid epidemic or a suicide crisis. But, there is a silver lining. Since 2012, new opioid prescriptions have been on the decline as physicians learned more about the medication’s addictive qualities. However, Brandeis University’s medical director of opioid policy research, Dr. Andrew Kolodny, said that doctors in the United States still write prescriptions for drugs like codeine, Vicodin, and OxyContin than doctors outside of the United States.


They also found that some patients who develop an addiction to these opioid medications switch to heroin. This is due to the fact that they either couldn’t get opioids from their doctors via prescription or it was cheaper. The CDC found that overdose deaths continue to rise because drug dealers are now spiking their heroin supply with fentanyl. Fentanyl is a very strong synthetic opioid. During August 2019 and August 2020, more than 88,000 people died due to an overdose. This caused health experts to advise physicians to stop prescribing these opioid medications for long-term usage.


President of the Society of Critical Care Medicine, Dr. Greg Martin, says that COVID-19 patients that get hospitalized due to the illness tend to get much more medication to help control anxiety and pain. This is especially true for those in the intensive care units. For example, patients who end up on ventilators get sedated to help keep them comfortable. Dr. Martin voiced concerns about the findings of this study because the study suggests that COVID-19 survivors are continuing to use medications unnecessarily once they get out of the hospital to help treat persistent symptoms.


Some surviving patients say that they are experiencing bone and muscle pain for the first time when they previously had none. However, other patients say that COVID-19 intensified their preexisting pain sensations to whole new levels.


One such patient is Rachael Burnett. She is a chronic pain patient who has experienced ongoing, chronic pain in her feet and back for over 20 years. This pain stems from a warehouse accident where she used to work. In April 2020, Burnett was diagnosed with COVID-19. Since she received that diagnosis, she claims that her chronic pain is 10 times worse than it originally was. She also claims that her pain spread to her spine and to the area between her shoulder blades.


At the time, Burnett was already prescribed extended-release OxyContin twice every day to help manage her pain levels. Due to her increased pain, her physician prescribed her a second medication called oxycodone. This opioid can help relieve your pain straight away. In December 2020, Burnett was reinfected with a second round of COVID-19.


Dr. Martin said that physicians should recognize that new or an increase in pain levels can be a part of long COVID. He proposes that physicians have to find a non-narcotic treatment option for this pain, just like they would with any other type of chronic pain. The CDC has a list of alternatives to opioid medications. These alternative therapies include biofeedback, physical therapy, antidepressants, over-the-counter anti-inflammatory drugs, and anti-seizure medication. These therapies can help reduce or relieve nerve pain.


Additionally, Dr. Al-Aly thinks that the United States has to come up with a viable strategy to cope with the patients who have long-term symptoms of COVID-19. He believes that it’s much better to prepare in advance than to get caught off guard in a few years when physicians see a surge in opioid usage. Dr. Al-Aly noted that the study he performed might not accurately capture the full picture of COVID-19 survivors’ needs. For example, most of the patients in the VA system are male while women make up the biggest portion of long COVID-19 patients in most other studies.


The director and founder of the Scripps Research Translational Institute, Dr. Eric Topol, said that Dr. Al-Aly’s study made it very clear that healthcare facilities in the United States aren’t ready to meet the three million long COVID-19 patients’ needs. He believes that we need a lot more intervention that will help to effectively treat these survivors. Dr. Al-Aly believes that COVID-19 long haulers may need treatment for years, and that this treatment is going to be a very large burden on the entire healthcare system.

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Group Telehealth: Opening the Door for Clinical Advantages and Operational Efficiency

SMART Management understands the effectiveness of group model delivery of clinical services. As a management company, formerly managing the Discovery House programs, SMART took an innovative and aggressive approach developing a robust Group Model for the delivery of clinical services, shifting away from a more predominant model consisting of nearly all individual sessions.A well-structured group program, with some clinics offering up to dozens of sessions per week and over 20 specialized group topics, proved to be well received by patients and associates and had an overall positive impact.

SAMHSA’s TIP 41 Substance Abuse Treatment-Group Therapy is a trusted resource outlining the advantages of Group Therapy. With Telehealth service delivery gaining increased momentum nationally, the latest SMART Telehealth Group Feature is the perfect opportunity to expand/develop an enhanced Group Therapy Model at your facility. In addition to the clinical benefits outlined below, making a connection with patient in a group setting is more critical than ever in these times of isolation.

The increase in stress and relationship between Mental Health issues and Substance usage is well-documented. A Fully integrated, HIPAA compliant SMART Group Telehealth Feature will set your clinic apart, creating that irreplaceable face to face group dynamic.

In addition to the clinical benefits, there are tremendous efficiencies with remote associates providing Group Sessions from the safety of their homes. The ability to schedule up to 16 attendees through the SMART Scheduler with automatic notifications and reminder messaging via e-mail and text, your clinical associates should be able to increase direct service hours and access to critical services more readily.

Treating adult clients in groups has many advantages, as well as some risks. Any treatment modality—group therapy, individual therapy, family therapy, and medication—can yield poor results if applied indiscriminately or administered by an unskilled or improperly trained therapist. The potential drawbacks of group therapy, however, are no greater than for any other form of treatment.

Some of the numerous advantages to using groups in substance use treatment are described below (Brown and Yalom 1977; Flores 1997; Garvin unpublished manuscript; Vannicelli 1992).

Groups provide positive peer support and pressure to abstain from substances of abuse. Unlike Alcoholics Anonymous (AA), and, to some degree, substance use disorder treatment program participation, group therapy from the very beginning elicits a commitment by all the group members to attend and to recognize that failure to attend, not being on time, and not treating group time as special all disappoint the group and reduce its effectiveness. Therefore, both peer support and pressure for abstinence are strong.

Groups reduce the sense of isolation that most people who have substance use disorders experience. At the same time, groups can enable participants to identify with others who are struggling with the same issues. Although AA and treatment groups of all types provide these opportunities for sharing, for some people the more formal and deliberate nature of participation in process group therapy increases their feelings of security and enhances their ability to share openly.

Groups enable people who abuse substances to witness the recovery of others. From this inspiration, people who are addicted to substances gain hope that they, too, can maintain abstinence. Furthermore, an interpersonal process group, which is of long duration, allows a magnified witnessing of both the changes related to recovery as well as group members’ intra‐ and interpersonal changes.

Groups help members learn to cope with their substance abuse and other problems by allowing them to see how others deal with similar problems. Groups can accentuate this process and extend it to include changes in how group members relate to bosses, parents, spouses, siblings, children, and people in general.

Groups can provide useful information to clients who are new to recovery. For example, clients can learn how to avoid certain triggers for use, the importance of abstinence as a priority, and how to self‐identify as a person recovering from substance use disorder. Group experiences can help deepen these insights. For example, self‐identifying as a person recovering from substance use disorder can be a complex process that changes significantly during different stages of treatment and recovery, and often reveals the set of traits that makes the system of a person’s self as altogether unique.

Groups provide feedback concerning the values and abilities of other group members. This information helps members improve their conceptions of self or modify faulty, distorted conceptions. In terms of process groups in-particular, as specific themes emerge in a client’s group experience, repetitive feedback from multiple group members and the therapist can chip away at those faulty or distorted conceptions in slightly different ways until they not only are correctable. The very process of correction and change is revealed through the examination of the group processes.

Groups offer family‐like experiences. Groups can provide the support and nurturance that may have been lacking in group members’ families of origin. The group also gives members the opportunity to practice healthy ways of interacting with their families.

Groups encourage, coach, support, and reinforce as members undertake difficult or anxiety‐provoking tasks.

Groups offer members the opportunity to learn or relearn the social skills they need to cope with everyday life instead of resorting to substance abuse. Group members can learn by observing others, being coached by others, and practicing skills in a safe and supportive environment.

Groups can effectively confront individual members about substance abuse and other harmful behaviors. Such encounters are possible because groups speak with the combined authority of people who have shared common experiences and common problems. Confrontation often plays a part of substance abuse treatment groups because group members tend to deny their problems. Participating in the confrontation of one group member can help others recognize and defeat their own denial.

Groups allow a single treatment professional to help a number of clients at the same time. In addition, as a group develops, each group member eventually becomes acculturated to group norms and can act as a quasi‐therapist himself, thereby ratifying and extending the treatment influence of the group leader.

Groups can add needed structure and discipline to the lives of people with substance use disorders, who often enter treatment with their lives in chaos. Therapy groups can establish limitations and consequences, which can help members learn to clarify what is their responsibility and what is not.

Groups instill hope, a sense that “If he can make it, so can I.” Process groups can expand this hope to dealing with the full range of what people encounter in life, overcome, or cope with.
Groups often support and provide encouragement to one another outside the group setting. For interpersonal process groups, though, outside contacts may or may not be disallowed, depending on the particular group contract or agreements.

The SMART Telehealth Group Feature helps you to carry on providing the tremendous benefits of Group Therapy, even if meeting in-person is difficult, especially during a public health emergency (PHE). The United States Department of Health and Human Services has already extended the COVID-19 PHE into April 2021 and, with that action, expressed its intent to continue such renewals to year-end or into early 2022. For more information on our substance abuse EHR software, contact us today.

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Telehealth Changes Made Permanent

It appears that the recent spending bill approved by Congress makes the provision of telehealth services permanent. The recent spending bill approved by Congress on December 21, 2020 does a lot to make the provision of telehealth services permanent.  

The new rule allows physicians to provide their first telehealth service to a patient as long as the patient’s last in-person visit was within the past 6 months. The law gives the Secretary the ability to determine eligibility beyond that six-month period. The Secretary has to establish their rules on a calendar year basis, so we shouldn’t have any worries for calendar year 2021.

Based on how that section of the bill is worded, it is apparent that telehealth services to mental health patients will be able to continue receiving telehealth services, even from their home, and that a telehealth service will actually be paid at the same rate as an in-person visit. For SMART and our partners, this is the most important provision of the bill because that was the major barrier to continue telehealth use post-pandemic.

What’s Beyond the Horizon for Telehealth?

Healthcare IT News surveyed 14 Chief Information Officers regarding ways that innovation could fill existing gaps in virtual care. Here’s what they offered in their responses:
Remote monitoring devices: Today we can measure pulse, temperature and oxygen but innovation in devices that can analyze blood, etc., would “bring telehealth to the next level”.
Complete patient engagement: Allow patients to fully interact with a shared screen to make selections, ask questions, interact with images, draw on the screen…a fully-interactive experience with the provider.

Artificial Intelligence: One CIO envisioned an “AI bot” to triage the patient before determining whether a provider should join the call; not based on preset questions, but more of a conversational exchange.

Peppa Pig?: For pediatric telehealth platforms a child would likely be more comfortable interacting with a beloved TV character than a doctor.
User-friendly technology:

One CIO noted that some patients have difficulty navigating the technology. and suggested improvements to make the user interface more friendly. Another envisioned a natural language translator which allows the provider to speak in English, allowing the patient to hear in their preferred language. Add others to the call: If a patient’s support system is not within their home, allowing the patient to pull-in family or others to join the call and offer what he termed “remote help”.

Virtual consult rooms: Two CIOs suggested to allow multiple providers (such as an internist, cardiologist and nutritionist to participate in a call with a patient to simultaneously discuss a health problem. Each would participate, documenting their own notes, offering the patient a “total healthcare experience”. Voice recognition: Using voice recognition for a provider to be able to automatically capture and transcribe notes into the patient’s record. The provider would only need to edit and sign the note later.

Predictive analytics: One CIO envisioned a full “clinician cockpit” with “analytic insights”, sensory and Internet of Things (IoT) data to “take timeliness, efficiency and positive patient outcomes to a new level”.

Everything!: When asked what feature they would like to see most, One CIO responded with “Why have to choose? A digital journey should afford synchronous, asynchronous, with voice, with video, with physiological monitoring, all in a single too. The elements of the tool that are enlisted will depend upon patient choice and clinical need. Today, these are many (largely) different tools.” Contact us today to keep up to date with these and other substance abuse EHR software news.