December 11, 2020
As president and chief executive officer of the Gateway Foundation, the largest nonprofit addiction treatment provider in the United States, Thomas Britton, DrPH, was already working to confront the opioid pandemic when COVID-19 began spreading. He says his training at the UNC Gillings School of Global Public Health Public helped him in unexpected ways when he found himself at the convergence of the two greatest public health threats the country faces.
With the number of overdoses on track to double, the United States faces the possibility of 150,000 deaths from drug overdose this year.
“Had you asked me a year ago what the biggest public health threat was in the country, I would’ve said ‘overdose,’” said Britton. “It was the leading cause of death for people over 50.”
Addiction treatment, whether outpatient or inpatient, has traditionally relied on in-person interaction, so the emergence of COVID-19 required rapid changes in operation for an organization that provides treatment for 9,000 people per day across nine states.
“A core of the disease of addiction is isolation, so recovery is compromised when we are unable to connect socially,” said Britton. “The Gateway Foundation response came from the need to build social connectedness in a time when you can’t physically connect.”
To figure out how to continue operating safely, Britton established a team tasked with analyzing risk and implementing solutions. In the beginning, when very little was known about the disease or how it spreads, and personal protective equipment (PPE) and testing were unavailable through either government of private channels, the team recommended a conservative approach, rolling out a virtual platform for all outpatient services. They kept residential programs in operation but for a brief period, ceased accepting new clients, to ensure the safety of clients already in the program. Shortly after, the team successfully reopened client admissions with a comprehensive test and trace strategy consistent with public health best practice measures for congregate living programs. Britton was tapped nationally to train physicians and providers on the model, increasing safety and access to care concurrently.
Through continuous monitoring of the effectiveness of virtual outpatient counseling services, Britton’s team was able to adapt. Diligent follow-up with clients taught them that a percentage did not respond well to the virtual environment or had problems with access. As the team learned more about remote treatment, more was learned about the virus, enabling them to tailor treatment to the needs of the individual – a hallmark of the Gateway Foundation’s remarkably successful approach. People were given support through a variety of means, including one-on-one counseling, when necessary. The foundation created a social app for its programs’ alumni and clients that also provides support tools and links to a 24-hour call center. Inpatient adaptations that have proven effective include a combination of PPE, testing, tracing and quarantining.
Britton says he was surprisingly prepared for this effort, owing to epidemiology classes he took as part of his Doctor of Public Health training in the Gillings School’s Department of Health Policy and Management. He entered the program to learn how to better manage the company he was running but notes that, at the time, mental health was not well connected to public health.
“It was really an interesting educational experience for me, the department and my cohort of what place addiction treatment has in the larger public health umbrella,” said Britton. “I have used my epidemiology training more in the past 10 months than at any other point in my career.”
Britton thinks this experience will have long-term implications for his entire industry. He notes that, though most providers were already working on digital strategies, Gateway was ahead of the curve. He sees this type of treatment as a boon for the opioid epidemic, the locus of which is largely rural, but points out that digital and health insurance infrastructure need to catch up.
“I think the permanent mark that will be left will be full-scale virtual services throughout the country, and the insurance health payers haven’t decided how they will pay for these services,” said Britton. “This issue, along with the need for expanded broadband access, will be expressed across the health care continuum.”
Contact the UNC Gillings School of Global Public Health communications team at email@example.com.