A University at Buffalo-led telemedicine study that can provide lifesaving treatment of Hepatitis C to those recovering from drug addiction has shown such promise that it has expanded across New York State.
Intravenous drug users put themselves at greater risk to contract Hepatitis C and HIV, two conditions that can be fatal if left untreated, and often are so focused on recovery that they ignore referrals for testing of those conditions.
Researchers at UB and elsewhere are in the midst of a five-year study that explores how effective it can be to bring that testing – and treatment when needed – to opioid treatment program clinics, with the help of specialists who can consult with patients through a laptop or mobile device.
“I think you'd want to be treated for both at the same time because the treatment for Hep C in many ways helps substance users get control of their lives,” said Dr. Andrew Talal, a hepatologist who leads liver disease research at the University at Buffalo Clinical and Translational Research Center.
“Patients are very happy when they find out that they no longer have to deal with Hep C,” he said. “It gives them a real benefit on the road to recovery.”
Talal is leading a $7 million statewide project funded by the Patient-Centered Outcomes Research Institute to find out if telemedicine can improve Hepatitis C treatment for patients who take methadone, and, if so, how it can work best. The Troup Fund of the Kaleida Health Foundation also is supporting the effort.
The research study follows a smaller pilot study outlined in the current issue of the medical journal Clinical Infectious Diseases, which shows promise for some patients. It is taking place at two opioid treatment programs in Buffalo – the Drug Abuse Research and Treatment Program and Catholic Health Pathways – six in New York City, two in Rochester, and one each in Syracuse and Newburgh.
COMPA – the nonprofit Coalition of Medication-Assisted Treatment Providers and Advocates of New York State – is helping with the effort.
“It's hard to get people to go to see the doctor when they want to go,” said Allegra Schorr, president of the coalition. "There are a lot of appointments, it's time-consuming and if you're not feeling well, it's even harder, so I think this is a really great idea. This is really groundbreaking. You can easily see that this is something that can be applied in many different settings, and for many different kinds of treatment.”
Coalition member programs now number more than 45 across the state and treat more than 41,000 New Yorkers – including people of all races, ethnic groups, religions and income levels.
“There's nothing mysterious about this,” Schorr said. “I think everybody knows someone who's been impacted, and that's just the truth about the opioid epidemic.”
Studies show that medication-assisted opioid addiction recovery tends to be more effective than treatment focused on counseling an abstinence alone.
It is possible for those without an opioid addiction disorder to get high on methadone and buprenorphine, but dosages provided in treatment have a different impact on those with a high tolerance to opiates, blocking the euphoric effect while tamping down what often are debilitating withdrawal symptoms best managed over months or years.
Methadone programs require participants to take the drug in person, as often as seven days a week, which gives treatment providers regular contact with those in recovery and tends to build confidence in those patients over time.
Talal suspected those relationships could build bridges to other medical providers who could improve the overall wellness of those eager to come off drugs but who still face the prospect of serious health issues, particularly Hepatitis C and HIV. Both potentially fatal diseases that can be transmitted by blood-to-blood contact, including the sharing of intravenous needles.
“The conventional method of treatment delivery – referral to an offsite location – has discouraged many individuals from initiating or completing treatment,” said Talal, also a professor at the UB Jacobs School of Medicine and Biomedical Sciences at and a physician with UBMD Internal Medicine.
That reluctance and noncompliance costs lives. Specialists who work with those in opioid addiction treatment estimate that roughly half their patients are chronically infected with the Hepatitis C virus, which attacks the liver. In 2014, the virus killed a record 20,000 people in the U.S., according to the Centers for Disease and Control and Prevention. Meanwhile, liver-related deaths due to cirrhosis and cancer also are on the rise.
About 80% of those infected with the Hep C virus go on to develop a chronic, potentially lethal infection. Treatments in recent decades were marginally successful, were administered by injection, had debilitating side effects and exacerbated mental health issues, all of which interfered with drug rehabilitation. All of that changed about six years ago when a new class of oral medications was approved by the FDA.
Those drugs generally harbor lower risks, fewer side effects and treatment success rates that approach 98% – when taken daily, and consistently, over the course of several weeks.
Both treatments seem a good match in the same space for those who have proven staying power in an opioid recovery program and are at higher risk for the Hepatitis C virus. That’s why opioid treatment programs jumped onboard to help Talal with the telemedicine study after the favorable results that were obtained in the pilot study.
The ongoing study has enrolled 500 patients and looks by the end of the year to add about 100 more – more than 10 times as many as in the pilot study.
Participating patients have first been referred to an offsite provider for Hepatitis C testing. Later, after at least six months, those who don’t follow through will be asked if they would like to get tested for the virus.
“The stepped-wedge study design, whereby each site initially refers patients offsite and subsequently implements the telemedicine intervention, is another extremely innovative aspect of the study,” said Talal, who acknowledged Marianthi Markatou, UB professor of biostatistics, for her contributions.
“The telemedicine evaluations take place in the methadone program,” he added. “We have also been able to have the Hep C medications delivered onsite to those who test positive so that they can be dosed with methadone. The help of the drug treatment and study staff is instrumental in walking patients through the process on a computer screen using telemedicine."
Study results are expected within 2 1/2 years; those interested in participating are encouraged to talk to the staff at participating treatment programs.
Those who become part of the study will be spread out evenly in number in a dozen clinics operated by the participating opioid treatment programs, all of which are COMPA members.
“From the pilot study and from what we're seeing already, telemedicine is something that is preferred by the patients,” Talal said. “They appreciate the one-stop shopping."
If the larger study confirms effectiveness, he said, “one day, a model like this could also be used for diabetes or other diseases where you need specialty knowledge,” and perhaps for primary care.