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Bicycle Health is a virtual addiction medicine clinic that treats opioid dependence or use disorder
Steven Loeb and Bambi Francisco Roizen speak with Ankit Gupta, Founder and CEO of Bicycle Health, a virtual addiction medicine clinic that helps treat opioid dependence or use disorder.
Our goal is to understand tech breakthroughs radically changing healthcare: the way we screen, diagnose and treat conditions and measure outcomes. And whether tech is helping or hurting our well-being physically and mentally.
Highlights from the interview:
- Gupta’s wife is an internal medicine physician so he heard more and more about how many patients with addiction or substance use disorders were showing up at the hospital. That led him to start talking to people in recovery, and hearing their journeys made him quickly realized this can happen to anyone, especially opioid use disorder, which typically starts with prescription use. He also heard about the stigma of addiction in our society, how people didn't want to be seen walking into clinics, how they weren't able to openly share their doctor with their spouse, how sometimes the doctors weren't even available, so there's a huge lack of access. That's he felt like Bicycle Health could solve, leveraging telemedicine and taking a clinical model that works really well for opioid use disorder treatment, and scale it in the way startups scale.
- 97% of the world's hydrocodone is consumed in the US, so a lot of the problem has to do with the culture and the system that we have built. Pain was added as one of the five vital signs about 15 or 20 years ago, so every single time you go to the hospital you're also asked about your pain. When you start asking people about their pain, then you have to do something about it and that's where an opioid prescription becomes an easy fix. A lot of the decisions we made over the last 10 to 20 years came from the cultural aspects of how pain should go away, we should not be in pain, and we should have a fix for the pain.
- An unintended consequence of trying to reduce the amount of opioids prescribed is patients who do have legitimate pain, and have been on opioids to manage it, end up not being able to access them anymore, so they have to go to the streets to continue getting opiates. That is causing other issues, for example we don't know how much fentanyl is in the street supply anymore, and that that is causing an increase in overdose death rates. That's where Bicycle Health comes in, the company wants to both prevent over prescribing of opiates, and opioid naive patients getting dependent on opiates, but then there are 10 million people who misuse opioids every year, and 90% of those people don't access treatment, so the company wants to have a strong addiction treatment industry that is actually available to take that large capacity of patients that need opioid use disorder help.
- Bicycle Health has built a comprehensive care model that includes medication management for both opioid use disorder and co-occurring substance use disorders and behavioral health conditions, along with psychotherapy, case management, and recovery coaching. It also does patient monitoring through randomized at-home drug testing, and all of it is delivered through its app and telemedicine. It also has a flexible care team that was built around the patient; they also stay with the patient, so it's a continuity care model, where it's the same medical provider who saw the patient initially following up with a patient. Even if the patient relapses and potentially comes back, they're connected to the same provider. That relationship is built throughout the care journey our patients have, and that relationship is really effective in behavior change.
- Only about half of the patients on Bicycle Health have a primary care provider and about half of those patients have felt comfortable sharing their opioid use issues with their primary care provider. Even after patients have shared this issue with their primary care provider, less than 10% of time they've actually gotten a referral to treatment.
- 70% of patients are able to see a medical provider the same day or next day, so the company has reduced that time quite significantly down from 14 days. Before the COVID public health emergency, when the regulation was in place that there needed to be an in-person physical exam before prescribing controlled substances over telemedicine, the median time from a patient calling Bicycle to getting started in treatment was four days.
- What's lost in the virtual care model is that the telemedicine level of care doesn't scale beyond a certain acuity. So, if patients have no safe place to store medication, if they're homeless, then telemedicine is not the right level of care for them because they have to go in person. If the patients have mental health conditions that make it challenging to understand how to adhere to medications, or how to safely take medications, or any functional adherence issues in any way, then they need a more in person level of care. Sometimes when patients have co-occurring substance use disorders, for example if they need to detox from alcohol, then they need in-person supervision. Often, Bicycle will refer patients to higher levels of care because they need that in person monitoring and medication adherence support that it can't provide.
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