By Patrick J. Kennedy and Corey McCann, M.D., Ph.D.
If there’s one thing even non-medical professionals have learned amid the greatest public health crisis of our time, it’s that detox alone frequently leads to relapse, often with deadly consequences.
Untangling the complex web of opioid addiction is a multi-faceted, deeply personalized, and lengthy process. One that requires connection to trained clinicians; the adoption of new skills and coping mechanisms; adherence to individualized treatment plans; and access to peer, community, and housing supports for a fighting chance at long-term recovery.
Neurological aspects of the brain disease of addiction must be addressed alongside powerful behavioral components: a true integrated approach. It is essential for the mind and body to be reunited through both introspection and medicine.
Research shows that when treating substance use disorders (SUDs), a combination of medication and behavioral therapies is the most effective. Medication-assisted treatment (MAT), which incorporates the use of FDA-approved medications, such as methadone or buprenorphine, combined with counseling and behavioral therapies, is the gold standard of care for good reason. The medications relieve the horrific withdrawal symptoms and psychological cravings that most often derail recovery, thereby allowing patients and providers to truly address behavioral concerns and help patients get their lives back on track.
This dual-approach to chronic care management is similar to the way other diseases are treated within our health care system. For example, patients diagnosed with diabetes are quickly taught to alter their diets and increase their activity levels through physician-led education sessions. These lifestyle changes complement medications that treat the disease and improve patient outcomes.
Sadly, those with mental health and SUDs still face a separate and unequal system of care due to a host of factors, including stigma, a lack of enforcement of the Federal Parity Law, and more. Many people – especially in rural areas – have to wait weeks or months to start or continue behavioral therapy or are forced to travel long distances due to inadequate networks of care or providers who simply can’t keep up with demand. Is it any wonder that over 70,000 people died from drug overdoses in 2017? Should we really be surprised that life expectancy dropped yet again? More than 80 percent of patients with opioid use disorder (OUD) do not receive or seek out care and only 13 percent of outpatient facilities in the U.S. offer MAT. Clearly, there is an urgent need for new and innovative therapeutics to bolster traditional treatment channels.
It is past time to embrace technology in our struggle for evidence-based solutions to the brain disease of OUD – and address head on the myriad of obstacles to care. Place of residence, access to transportation, or physical ability to attend treatment sessions should NOT determine life or death in a modern, technologically-advanced society. We must bridge the gap in treatment by delivering multi-modal therapy in combination with MAT in ways that are designed to be more effective, more convenient, and more accessible for patients and clinicians.
Fortunately, in December, the U.S. Food and Drug Administration (FDA) granted clearance for a first-of-its-kind prescription digital therapeutic (app) that provides cognitive behavioral therapy as an adjunct to outpatient treatment that includes buprenorphine and contingency management to patients currently under clinician care. This groundbreaking decision deserves a spotlight, as it will set a new standard for treatment moving forward.
First and foremost, the FDA authorization will open doors for many more people to access care. Interactive, mobile therapy lessons and skill-building exercises do not require a waitlist, a long drive, or, for that matter, a car. Not only is this a game-changer for people in rural areas, but it will also help people who don’t have the flexibility to accommodate regular face-to-face therapy sessions due to jobs, family obligations, etc. And while prescription digital therapeutics should never replace the powerful interpersonal connection of traditional behavioral therapies, they can absolutely complement treatment programs – and serve as a new evidence-based tool in the toolkit for combatting a complex public health crisis, while we push to expand our workforce of providers.
Secondly, it further propels the model of MAT and the critical role it will play in addressing rising death rates from overdoses and suicides. Individuals struggling with OUD – and their families – must all stand up and demand evidence-based care.
Finally, the FDA authorization reinforces what recovery advocates have been saying all along: we must treat the whole person. Learning to live a new normal in the absence of drugs is one of the hardest things a person can go through. Adapting to healthy behaviors that replace rewarding feelings does not come easily. It takes guidance, practice, self-discipline, and consistent application. Prescription digital therapeutics are poised to help patients build on these skills and to foster better collaboration and communication with a patient’s clinical support team.
We are also encouraged by the overwhelming bipartisan support for and passage of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. The bill, which will increase funding for inpatient SUD care, as well as for treatment of OUD, and expand the number of clinicians who can prescribe MAT, is an important step forward in addressing the opioid crisis.
Mental health professionals often say that facilitating human resiliency is one of the most rewarding components of their job. In the face of a devastating national crisis, we must nurture that sense of hope, that drive for survival – and do everything we can to encourage and sustain it. We need tools. We need roadmaps. We need best practices to be disseminated far and wide. Technology can serve us greatly in this capacity. Now, more than ever, we must keep our minds open to the possibilities that technology affords and to continue to build a robust infrastructure of support for those who need it most.
Patrick J. Kennedy, former U.S. Representative (D-RI), is the founder of The Kennedy Forum, a former member of the President’s Commission on Combatting Drug Addiction and the Opioid Crisis, co-founder of One Mind, and author of the New York Times bestseller “A Common Struggle: A Personal Journey Through the Past and Future of Mental Illness and Addiction.”
Corey M. McCann M.D., Ph.D. is the president and CEO of Pear Therapeutics, a company developing prescription digital therapeutics for treatment of serious disease. Pear received FDA authorization for reSET-O, the first FDA-authorized Prescription Digital Therapeutic for patients with Opioid Use Disorder, in December.