Solving opioid abuse will require more than well-designed digital interventions

By Dave Muoio
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Opioid abuse is among the most pressing issues in healthcare, so it’s no surprise that the epidemic was a major topic of discussion at CES 2018’s Digital Health Summit. Following a lengthy discussion about the national crisis’ societal factors and specific digital-based interventions, a panel comprised of industry experts and academics repeatedly found themselves in agreement that no one approach will be sufficient in and of itself.

"This is a complex, bio-psycho-socio problem. … To make inroads in something of this complexity requires a multidimensional approach,” Dr. Brennan Spiegel, director of health services research at Cedar-Sinai Hospital, said during a roundtable session. "There’s all sorts of arms and legs to [the opioid epidemic] — that means there’s great opportunities for innovators and developers ... but the idea of one thing being the magical key to unlock an epidemic of this size is fallacious."

Part of the challenge is that the epidemic is not necessarily driven by malpractice or poor judgement, but compassion and a legitimate desire to ease patients’ discomfort, Dr. Richard Migliori, executive vice president of medical affairs and chief medical officer at United Healthcare, said. Because there are expectations from the consumer and a history of abundant prescription backed by regulators and the President’s Joint Commission, the pattern of unnecessary prescription will need to be addressed at the physician level — a challenge that technology may be able to lessen.

“You’ve got to be able to provide the physician with a decision-support platform that allows the physician who is [treating] the pain to be able to respond quickly,” Migliori said. “The ability to look at the guidelines for the right kind of drug at the right time for the right reason is important, but also [technology can] do things that a physician isn’t really able to do because we have to go purge and query other databases that may have [information] about that certain patient. You’re starting to see the emergence of these handheld technologies to do that sort of thing.”

In many cases, the challenge is not in developing new technology but in appropriately implementing what is already available, Spiegel noted.

“How do we actually get it into the hands of patients?" he said. "What we’re working on now is how we actually put virtual reality, for example, into an order set? If an orthopedic surgeon is about to do an operation, how does she order virtual reality? So we’ve developed a virtual reality consultative service, called the virtualist, and that’s our job, to go and tailor the VR experience to that individual and prescribe it.”

That’s not to say that tech-based opioid prescription interventions should be aimed solely at the provider. Dr. Shai Gozani, president, director, and CEO of Neurometrix, highlighted the patients themselves as potential corrective players, an opportunity available thanks to the low-risk nature of digital therapeutics and the growing awareness of opioid abuse among the public.

“Many consumers, they understand the risks of prescription opioids and are looking for alternatives,” Gozani continued. “The word is getting out — at one level, just educating the population about the risks and the alternatives is very effective, because they will then take the initiative to find alternatives.”

Gozani — whose own company has chosen the direct-to-consumer route for its product, Quell — said that he believed the health systems’ need for extensively proven efficacy and cost-effectiveness is likely among the limiting factors when it comes to swiftly implementing digital alternatives to opioids on a large scale. Migliori, in response, explained how health plans like his are increasingly becoming more open to groundbreaking approaches to care.

“This is a particular area in which health plans have evolved, and if they haven’t they die. We need to be able to spark innovation, but we can’t be in a circumstance in which we’re just paying for anything that hits the wall. What we’ve done, and we’ve done historically with bone marrow transplants and breast cancer, is carve money out … and allow people to experiment with good scientific protocols and legitimate science,” Migliori said. “When those kinds of results come back … then we can rapidly drive their adoption.”

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