SEATTLE -- Denny Bos's ministry is the foothills of Mt. Baker, in east Whatcom County, Wash., a vast forest home to hundreds of people without addresses. Some live in ramshackle RVs, some in tents, some under tarps.
People go there when they lose their jobs or homes, when their addictions get too serious, or to get away from society, Bos said.
"They just disappear into the woods," said Bos, who's had to build trust to be accepted into the camps.
When Bos, a former pastor who runs Seeds of Hope Ministries, finds someone who's ready for drug treatment, it used to be hard to get them to go see a doctor -- the trip to the nearest clinic in Bellingham is 45 minutes, and the foothills' campers can be reclusive.
But that's changed since COVID-19 reached the U.S. and Washington's governor ordered the state to stay at home. In response to the pandemic, restrictions around in-person visits to prescribers for medication-assisted treatment have been suspended across the country, restrictions on billing phone visits to Medicaid were eased, and providers began expanding telemedicine options. At many clinics, you can now get a substance use disorder assessment over the phone, and pick up your prescription at a local pharmacy.
Leading experts in the field want the changes to stay, at least until expanded access can be studied. Twelve members of the federal Interdepartmental Substance Use Disorders Coordinating Committee wrote a letter to federal officials this month asking for the rule changes to stay in place after the pandemic so researchers can study their effects.
To Jim Vollendroff, director of the Behavioral Health Institute at Harborview Medical Center, who has been training providers around the state in the telemedicine expansion, it's one bright spot in the darkness that is COVID-19.
"During this time, which is a devastating time, the silver lining for healthcare in particular, is we've been sitting on the sidelines; we've been wringing our hands" when it comes to expanding telemedicine, Vollendroff said, because of complicated medical privacy regulations. But since COVID-19, "I have seen at least five years worth of progress happen in four months," Vollendroff said.
This does not mean more people are getting treatment in Washington: Between March and June, the number of Medicaid patients in Washington in opioid treatment programs, outpatient treatment, recovery houses or other services for substance use dropped 17.7%, according to data reported to the Washington State Healthcare Authority.
But the sudden jump to telemedicine could pave the way to make it much easier to get into drug treatment, Vollendroff and other experts think.