Friday, November 10, 2017

Telemedicine app could help address rural opioid addiction

"For President Donald Trump’s national emergency on opioid abuse to get traction in Appalachia and the rural South, the treatment effort will have to overcome some stubborn logistical barriers — and an obscure legal hurdle complicated by the president’s own push to reduce regulatory burden," Tony Pugh reports for McClatchy.

The logistical barriers to treatment in rural areas include fewer available medical care options, transportation problems (no car, too long a distance), and widespread poverty. Trump's limited emergency declaration included a call to expand telemedicine services so specialists can treat rural patients remotely via video conference. The National Institutes of Health is funding a $1.7 million study of an app called "emocha" that could help doctors remotely monitor whether rural patients were taking daily anti-addiction drugs like buprenorphine. The patients would use their phones or tablets to record themselves taking their meds, and send it to their doctor for verification. Patients could also report cravings and side effects in the app. The app can also be used to monitor patients with tuberculosis, HIV and hepatitis C.

"Other emerging technology, such as online digital counseling apps, along with pharmaceutical innovations including longer-lasting doses of buprenorphine could help bridge the geographic and clinical gaps faced by opioid abusers in isolated areas," Pugh reports.

There are some problems with this approach. For one, limited access to broadband internet may limit the feasibility of telemedicine, especially in very rural areas. And a federal law designed to crack down on shady internet pharmacies is stopping doctors from prescribing controlled substances without an in-person consultation first. The American Telemedicine Association has been trying to get a federal waiver for the Ryan Haight Online Pharmacy Consumer Protection Act for nearly a decade, but say the Drug Enforcement Administration has been slow to respond.

"DEA spokesman Rusty Payne said the agency is working on the waiver guidelines, but it’s unclear when the waiver will be ready and what it will entail," Pugh reports. "A senior DOJ official suggested the effort could be delayed by a Trump executive order that discourages creation of new rules by requiring agencies to eliminate two rules for every new one created. The White House did not respond to questions about the matter."

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