In the midst of the COVID-19 pandemic, U.S. drug overdose deaths have surged. The CDC estimates that more than 107,000 people died in 2021, an increase of nearly 15% from the more than 93,000 deaths in 2020. 

But the pandemic also has brought a sudden boost in telehealth utilization. Regulations surrounding telehealth prescriptions of controlled substances were loosened during the public health emergency, allowing for providers and startups to offer medication-assisted treatment like buprenorphine for opioid use disorder. 

One of those companies, Bicycle Health offers virtual care as well as prescriptions for medication. CEO and founder Ankit Gupta and Medical Director Dr. Brian Clear sat down with MobiHealthNews to discuss the treatment landscape for patients struggling with opioid use disorder and the startup's recent $50 million Series B raise. 

MobiHealthNews: Why do you think that telemedicine works well for this population?

Dr. Brian Clear: It is all about access. So, we know that only one in 10 patients with a substance use disorder is actually getting treatment in the past year. There are a lot of reasons for that, mostly surrounding geographic access. Forty percent of counties in the United States don't even have a provider who's registered to provide you with buprenorphine for opioid use disorder. 

There's also stigma. Especially in towns where people in their health system or their neighbors know who they are, patients are reluctant to show up at these programs, which are certified licensed programs for addiction specialty care, and it's known that these programs offer addiction specialty care.

In our program, we find that 30% of patients reaching out to us have never been diagnosed with opioid use disorder before and have never accessed care for opioid use disorder before, which is really remarkable. That means we're appealing to people who otherwise don't access any other level of care. We're finally breaking that cycle of just serving the same small, tiny subpopulation of patients over and over again.

Ankit Gupta: Yeah, and I'll give you an example. There's a new regulation in Alabama that went live recently, where an in-person examination is needed within the last 12 months to prescribe a controlled substance. We, for the last almost two months, had a whole task force working tirelessly to help our hundreds of patients find local providers in Alabama. 

After all of that effort, we still found that less than 20% of patients actually found a local provider. It's because the providers weren't available. They weren't affordable. There was a lot of stigma like Brian mentioned. We've had reports where patients don't want to be seen walking into clinics; they don't want to have their car parked outside. So, we were in dire straits. 

We had to literally fly a couple of providers to Alabama and spend a week there just to comply with the regulation so that we can continue taking care of the patients we have. We're not enrolling any new patients, but to continue taking care of the patients we have, until we find a suitable option for them on the ground. And so, there's just a massive, massive lack of access. 

MHN: There has been an increase in overdose deaths over the past few years. What have you heard from patients about their experiences accessing care?

Clear: It's always been dismal, and access has not gotten worse over the past two years. What has happened is that fentanyl is now present almost universally in the illicit drug supply. So, patients who are using illicit opioids are much more likely to overdose than they ever were in the past. 

COVID kept people in their homes for a very long time and made people even more reluctant to access the resources that were already very limited. Now, I think we're starting to get past that, and people are returning to more normal lives. So, I can't say that COVID restrictions are keeping people out of care anymore. 

But we're now in a place where it's not just fentanyl; it's new analogues of fentanyl — that are even more potent — that are in the illicit drug supply. 

Gupta: We sent a survey to patients about four or five months ago. There were about 1,000 patients, and we asked them many questions, one of which was about their outlook on recovery and addiction treatment during COVID. 

And what we learned was quite different from the narrative out there. We learned that 77% of our patients said that the pandemic has not made maintaining or achieving recovery more difficult. In fact, 42% said that it has made it easier. So, again, it goes to show how telehealth can really improve access.

MHN: Bicycle Health recently raised a $50 million Series B. How do you plan to use that investment?

Gupta: So far, we have been quite successful at reaching patients; we've served over 17,000 patients so far across 26 states. But we're still getting started. 

We're going to use this investment to continue increasing access to opioid use disorder treatment. That includes hiring medical providers to be able to grow the capacity to see patients, building our technology that helps us both deliver the care as well as increase the quality of care through data analytics and patient engagement tools that we've built in-house through our randomized at-home drug testing program.

We've also been quite successful at partnering with health plans. We're seeing strong demand, both from commercial as well as from Medicaid managed care plans, to both increase access by decreasing cost of this patient population. So, we're investing in increasing those partnerships. 

We've now started receiving inbound interest from providers who want to work with us, either referring patients to us or co-managing patients. We want to use the investment to also increase our partnerships with medical providers, case managers, discharge planners, especially in the correctional health setting but also with employers to reach patients.