In the wake of controversial telehealth rules proposed by the Drug Enforcement Administration (DEA) last week, some are criticizing the backward steps the rules represent. Under the proposed rules, most controlled substances used to treat opioid use disorder (OUD) would require at least one in-person visit.
I’m not in favor of this roll-back of progress, but as the founder of the company that invented telehealth services for substance use disorders (SUDs) treatment and recovery services in the US, I have some feedback for our industry.
During the pandemic, the telehealth mental health industry got its “driver’s license” (in retrospect, maybe it was a learner’s permit!) with the temporary suspension of regulations surrounding the prescription of these drugs without an in-person visit. Pretty much the whole point of telehealth is not to have an in-person visit. This factor allows for the really big benefits of telehealth to be realized, rather than just the incremental benefits that already in-person patients will realize from the addition of telehealth visits to their existing relationships.
What happened? Two things. First, our venture capital communities funded companies whose primary business model is the prescription of these medications. Second, they pressured their start-ups to grow at VCs’ typical rocket ship rates of growth. So they did.
If you haven’t been following along, new mental health entrants like Cerebral powered ahead, burning through the $462 million in capital they’d raised. Along the way, the wheels started to come off, as major pharmacy players alleged lax prescribing standards and stopped honoring their partnerships with Cerebral. Walgreens and CVS stopped filling Cerebral’s prescriptions, and later a former vice president of product and engineering at Cerebral filed suit against the company, claiming that Cerebral “egregiously put profits and growth before patient safety.” A few months after that, a scathing article about our field was published in the Wall Street Journal in which a former nurse practitioner employed at another “medical model” company observed about her company that “they’re building a Suboxone vending machine”.
Most recently, a very promising treatment modality that relies on psychedelics has emerged, with several new companies racing to promote its use. Ketamine is the first psychedelic treatment being promoted because it is already legal and is effective in treating many mental health disorders, including SUDs. At Lionrock, we are ready with a telehealth psychedelic treatment protocol using Ketamine. But we are taking it slow, with an emphasis – which we believe is only logical – on patient safety. However, there are several other companies which will simply send you a month’s worth of Ketamine lozenges in the mail. We know because we ordered them to see if those companies would really do something so foolish. It’s against this backdrop that the new rules, which are more or less the old rules, were formulated. Should we be surprised?
If our industry wants to get back into the driver’s seat, we need to treat the whole person, not just the substance problem. How is that different? Substance use disorders almost always result from people self-medicating mental health problems. At Lionrock, 70% of our patients have a diagnosable co-morbid mental health disorder. If you only treat the substance problem, you’re not treating the root cause of the problem. Without treating the root problem, you can’t get a sustainable, long-term solution for the substance problem.
Research shows that medication can play a significant part in SUD treatment. In proper measure, it is a net positive. But when we leave out the other important parts of SUD treatment, and push medication because we like the business model better, we prioritize profits over the recovery and well-being of our patients. At Lionrock, we’ve spent more than a decade working to demonstrate the efficacy of telehealth SUD treatment and delivering superior results based on treating the whole person. The last thing our field needs is the kind of self-sabotage that encourages more regulation.