Becker's recently connected with Ophelia Chief Medical Officer Arthur Robin Williams, MD, to discuss how the virtual opioid use disorder treatment provider is connecting patients with live-saving medication for addiction treatment.
Note: Responses have been edited for clarity and brevity.
Question: How is Ophelia working to address the idea that in order to receive help for addiction, patients must attend rehab or other inpatient or outpatient programs?
Dr. Arthur Robin Williams: There's a narrative that in order to get help, people have to go to rehab. Amy Winehouse, who died, had a whole song about not going to rehab. The whole rehab thing is inaccurate, it's a myth. We actually created a campaign, not against rehab, but it started with an F. The point was, we think that it is killing people, this idea that you have to "go to rehab" in order to get help. When we're talking about, very specifically, opioid addiction, there's really no evidence at all that "rehab" or inpatient or residential saves lives at all. … There's two things that save lives, and it's getting people on medication and helping them stay successfully on medication. That's what reduces overdose. The level of care is the nomenclature in the industry. Whether you're an inpatient and outpatient and residential, a group program at a private clinic, office, whatever it is, none of that matters. What matters is helping people get on to buprenorphine and helping them troubleshoot how to stay on it successfully.
At Ophelia, in our first month of care we have over 70 interactions with the patients in the first month. A lot of that is with our care coordination services to help patients troubleshoot problems in life and a lot of that is related to pharmacies and insurance. It's not about being in a rehab, residential or sober house, anything like that. None of that is evidence-based in terms of helping patients. What really matters is getting onto a medication like methadone or buprenorphine and staying — not for a couple of months, but two to five-plus years. Our whole system is kind of fragmented, siloed and not designed to help people get on medication and when they get on medication, it's not designed to help them stay on it successfully.
Q: What is the process of going on those medications, and how do they help addiction patients?
ARW: By the time someone gets into treatment, whether it's with me or anyone else, they've been doing the same stuff for a long time, not for months, but for years or decades. That means when someone comes into care, it's not going to be a surprise that an individual may continue to struggle with drugs or alcohol or whatever it is. The point is to help nudge someone in a healthier direction. In terms of medications for opioid use disorders, the National Academies of Medicine came out with a book in 2018 and it's literally called Medications Save Lives. One of the themes that they really hammer in the textbook is that people should have access to medications, even if they're not interested in group therapy or programs. What really saves lives is medications. If you talk to people who use heroin, street opioids, typically people are using multiple times a day, so it's like this roller coaster effect. You will use it about every six hours. Pharmaceutical companies — when we're talking about prescription opioids — claimed that medications lasted for 12 to 18 hours. The reality is most full-agonist, analgesic opioids last for about six to eight hours. If you look at the behavior of people using heroin, they're going to use one to two to three bags every four to six hours. It's a roller coaster so people have highs and lows, peaks and troughs. With methadone or buprenorphine, these are medications that last for 24 to 36 hours, so someone takes the medication and they have a steady state blood level and that's just the case.
There's no more peaks and troughs, there's no more thinking about using, there's no more highs and lows. Whether someone's on 100 milligrams or 300 milligrams of methadone or buprenorphine, the blood levels are highly consistent, and the person is cognitively intact. There's no withdrawal, and cravings are suppressed with these medications — they are the first-line, gold standard treatment. They're under the WHO's list of essential medicines because they're so life saving.
Q: How does Ophelia's platform work to connect with patients?
ARW: I think there are a lot of myths about telehealth. Ophelia is real-time, face-to-face clinical care that is designed exclusively for a remote care environment. So it's intended to be best-in-class care, but delivered virtually without the need for in-person services. … The patients love it, because they say, 'You're nice to me, you saved my life, I can be a mother again, you're in my pocket at all times.' There are ways that telehealth can actually be much much better than in-person care. What we've created is a way to get the best parts of in person-care into the patient's pocket so that we're always with the patient. A lot of our patients they're you know, at home, and there's three kids bouncing off the walls behind the sofa. They're in the car on a lunch break at the factory where they work, they're on their farm and they step away from the tractor. We're literally taking the care directly to the patient and making it so convenient and private. … This is all real-time, face-to-face synchronous care. And the team stays with the patient for the whole care episode. We started in March 2020 and so now we've had patients for over three and a half years who have been with us. This is a very legitimate, safe, effective, impactful care platform.
Q: How can patients pay for Ophelia's telehealth services?
ARW: We are priding ourselves getting in-network with every Medicaid plan in the country. If you look at Medicaid populations, such as low-income or disabled individuals, the prevalence of opioid addiction is about four to 12 times what you would see in the general population. Medicaid is the number one payer for addiction care in the U.S., especially since 2014, after the Affordable Care Act. We are very committed to being in-network with every single insurance plan, especially Medicaid plans, because we know that that's where the need is. We're not looking for lucrative contracts, we're looking for very middle of the road, reasonable contracts to scale access to affordable evidence-based treatment.
Q: As you look to the future, what's next for Ophelia?
ARW: Ophelia is eager to partner with hospitals. I've worked in, I don't know, 10 or 20 hospitals over the years and there is a reluctance even now to start patients on buprenorphine, unless there's an identified outpatient prescriber. … The concern is starting someone on a medication, discharging them home and then the patient not being able to continue the medication in the outpatient setting. There's really a need to dramatically rethink that. Ophelia can be a standalone treatment platform, it can be a supplemental platform and it can be a safety net. I just published this study with colleagues from Columbia and Rutgers. We found in Medicaid populations that if you look at people who have an overdose, and it's treated in a healthcare setting like an emergency room or hospital, within the next year 6.5 percent of those patients get medications to treat the underlying disorder. It's astounding, almost 95 percent of people who almost died don't get treatment. The hospitals and emergency departments have a huge opportunity to connect people with treatment, but they're reluctant to do it because they struggle identifying outpatient prescribers. This is literally what motivated our company to come into existence, because now the social worker, the case manager, or the ER physician, whoever it is, can literally have the patient go to ophelia.com and within one day, the patient's going to be seen by a clinician and started on life-saving medication. We've treated over 10,000 patients, and we're eager to do it.