Angela Jepson has tried several drug treatment programs over the years, but recently she has found something that works.
She receives treatment from Ideal Option, a provider with clinics throughout northern Idaho. She has been going there for about a year, regularly for the past six months, and has been able to obtain treatment by seeing her doctor in person or through telehealth.
Jepson has struggled with opioid addiction for about 18 years, and suboxone, a drug that helps curb his cravings, allows him to live his life more freely and healthier.
Ideal Option offers drug-assisted treatment for opioid addiction as well as treatment for addiction to other substances, including alcohol.
Recently, Ideal Option received state funding to expand its services, opening clinics in Kellogg and Sandpoint.
This expansion was made possible, in part, by changing regulations regarding telemedicine in Idaho.
Before the pandemic, Dr Richard Mattis had to see patients in person on their first visit to an Ideal Option clinic because state law required him to establish a provider-patient relationship.
When the pandemic struck, the governor and the Idaho Department of Health and Welfare changed the telehealth law to make it easier to accommodate patients without putting their health at risk.
Mattis has cared for many new patients via telehealth, building relationships with new treatment-seeking patients who have walked through the door – even though he could only see them through a video screen.
Telehealth for addiction treatment has opened up options for people living in rural northern Idaho and even western Montana, Mattis said.
“You can’t do large scale drug treatment in Idaho without telemedicine,” he said. “If you don’t have telemedicine, you have to have a provider in each clinic at all times. “
Ideal Option recently opened new treatment clinics in Sandpoint and Kellogg. Mattis said this extension is only possible with the changed telemedicine rules.
He can’t go to those clinics every day and wouldn’t go up there just to see one or two patients, especially when he can now see patients in multiple clinics every day. These more rural treatment clinics will still have staff: a medical assistant and another assistant to register people and perform their urinalysis or other tests as part of their treatment. Then they can see the doctor by video.
Patients who previously had to drive from outside Kootenai County or even Montana to Coeur d’Alene to see a doctor to begin treatment with Ideal Option can now visit clinics closer to them.
Mattis said he saw two walk-in patients, despite a busy schedule, one day in mid-December. Telemedicine allows her and other providers offering similar treatment to do what they know works best in drug treatment: offering services when someone asks for them.
“The most important thing with these patients is that you have to meet them here, now, and when they say they’re ready, we have to be ready now – not in two weeks,” Mattis said.
The Idaho Department of Health and Welfare also amended the Telemedicine Act to allow providers to be prescribers once they have established a relationship with the patient through telehealth.
This is the key to drug-assisted treatment, which is evidence-based drug treatment, especially for opioid dependence. Mattis said he sees a lot of patients addicted to fentanyl and heroin, both of which are opioids.
Medicines like suboxone can curb a person’s cravings. Treatment is also preferable to the alternative, which can lead to overdose.
In 2019, 134 opioid-related deaths were reported in Idaho. In 2020, there were more: 164.
The Idaho Department of Health and Welfare plans to keep most of the changes to telehealth access in Idaho in perpetuity, said David Bell, deputy administrator for policy and innovation at Idaho Medicaid.
Bell said the expansion of telehealth due to the pandemic has been “a very good thing.”
“As our manager likes to say, we gained about 10 years of work in about 6 weeks and it was intense, but we got it where people can get the services they need,” Bell said. .
Idaho is a very rural state and increasing access to health care, even virtually, is a victory, he said.
Almost all of Idaho is considered an area of health worker shortage, and rural counties experience higher uninsurance and poverty rates than urban counties. In northern Idaho, four of the five counties are considered rural by this definition.
“We are short of providers in all areas, so the more health care providers we can have, the better off Idahoans will be,” Bell said.
When the pandemic struck in early 2020, access to telehealth care skyrocketed in Idaho, according to department data, and then ran out of steam as the pandemic progressed.
In April 2020, more than 90,000 Medicaid telehealth claims were registered by the department. That number has slowly declined as the pandemic progresses, but even as of November 2021, just under 20,000 Medicaid telehealth claims had been processed.
“For the record, we’ve heard from vendors that their cancellation and skip rates are going down because there’s no barrier to getting to the office physically,” Bell said.
For rural northern Idaho, the shift in state policy, according to patients and providers, will continue to expand services to those who need them.
For clients like Jepson, having access to a doctor when needed is vital. Ideal Option’s providers were flexible and open to her returning sooner than expected if she needed it or felt like she wanted to speak to her doctor sooner.
“This is what made me persevere,” Jepson said.
Every three weeks, she goes to the clinic, has a urinalysis test and talks to a provider either in person or on a video screen before getting her prescription for suboxone. She has a strong support system around her, including a Celebrate Recovery group, which she says has helped her stay stable and consistent with treatment.
She said she hoped others like her could get treatment and knew there was help there.
For Mattis, drug treatment is more than just prescribing drugs or seeing a patient online.
“We say to each of them: Your prescription is something in the bottle, but you can come see us if you feel like you’re going to relapse. Come in and come in, ”he said. “I want to see you right away.”