A project by Acumen America

Addiction treatment in this country is broken. We’re meeting people where they are.

Boulder Care is working to provide people with the treatment help they need. 

Stephanie Strong is the founder and CEO of Boulder Care, a company that provides telehealth addiction treatment, grounded in science and rooted in empathy.

Addiction treatment in this country is broken. In 2020, deaths by drug overdose in the United States surged to an alarming 93,331—a 30.9% increase from the previous year and the largest single-year increase on record since 1999, per the CDC. Yet, our entrenched approach to this crisis often requires people hit “rock bottom,” face an “intervention,” and then retreat to an expensive 30 to 90-day in-patient treatment facility where they are mandated to individual and group counseling.

From this all-too-common portrait, we are left to draw three harmful conclusions: People experiencing addiction can’t get well until they’ve lost everything; loved ones can only help by cutting off their support; and one month of intensive counseling, away from work and family, and at the cost of tens of thousands of dollars, is the first step toward recovery. 

More subversive and damaging is our unspoken assumptions that those with addiction have lacked the moral fortitude to get well on their own, leading to the idea that this condition be treated by non-medical specialists pushing faith and abstinence, which the research has shown leads to increases in overdose and death. 

Addiction is one of the most stigmatized medical conditions in our country: only 22 percent of Americans would be willing to work closely on a job with a person with drug addiction, compared to 62% who said they would be willing to work with someone with mental illness, per a John Hopkins study. What’s more, as a country, we’ve criminalized addiction—disproportionately so in Black, Latinx and Indigenous communities—incarcerating instead of treating this chronic condition. 

But access to life-saving medication, like buprenorphine, is constrained nationwide, and those who do get medication treatment for addiction are overwhelmingly white. Over a three year period beginning in 2012, nearly 95 percent of healthcare visits that resulted in a prescription were for white patients—for every 35 white patients that received a buprenorphine prescription only one patient of another race or ethnicity did. This despite overdose deaths rising faster for Black patients. 

And yet, effective treatment exists. Which is exactly why I founded Boulder Care: to provide evidence-based, culturally-informed, and affordable addiction treatment for people wherever they are, whenever they’re ready. 

How did we do it? 

We hired world-class engineers to build a private and secure platform on which people could receive care from the comfort of their home after putting their kids to bed or on their lunch break, and many places in between. Bringing the care to people on their schedule, rather than demanding people come to the care. 

We recruited exceptional care providers: clinicians with backgrounds in family and addiction medicine, as well as psychiatric and mental health; but just as importantly, care advocates who are trained to navigate insurance and pharmacy issues; and peer recovery coaches with lived experience of addiction and recovery and nationally-certified training to support Boulder patients on their path to recovery. 

We also creatively partnered with health plans—commercial plans used by employers, state Medicaid plans, and Medicare—that reimburse Boulder for the individualized care we provide, not on the basis of how many clinical visits or drug screens someone receives (neither of which have led to better patient outcomes). Which means we’re paid based on our ability to help people get well, realigning incentives to retain patients in care, a direct link to health outcomes and reduced healthcare costs. In this way, we are making care affordable to the corporate executive, the warehouse worker, and the un- and under-employed, alike. 

And, it’s working. We’ve enrolled patients from Alaska to Ohio. Over 70 percent of our patients have been retained in care at 12 months, double the industry average. That’s important because we know that it takes time for the brain to heal. 

What’s more, patients like the care they receive. “There aren’t enough words to describe the many benefits I’ve received as a chronically ill, low income opioid use disorder sufferer from this program and my most excellent care team,” one patient says “Nor are there enough to express my gratitude to all who make this easy, convenient evidence-based program available to people like me.”

COVID-19 revealed how America’s healthcare system fails those who lack access and resources. This was acutely felt in the addiction treatment industry. Meetings went virtual. Those seeking face-to-face care couldn’t get it. Some in treatment lost their employer-provided insurance because of job loss. And as a result, more people in our communities died. 

Thankfully, Boulder was positioned to help those who needed it the most, using an Acumen America grant that allowed us to subsidize or cover the cost of addiction treatment for those who would not otherwise be able to afford it, like people whose insurance benefits were suspended while they were incarcerated. 

But we have so much more work to do. ​​

Culturally, as a society we need to see addiction differently. Like a chronic condition, not a moral failing, particularly for BIPOC patients. A person living with diabetes takes insulin throughout their life to manage their condition—so too might a person living with a substance use disorder take buprenorphine. Similarly, a return to use is a symptom of a chronic disease, not a recovery failure. Our job is to keep people alive and to help them get well. That means seeking to reduce harm wherever possible, including continuing—not withdrawing—care for those who continue to use drugs. 

Practically, we should make permanent the Public Health Emergency waivers that enabled increased access to SUD treatment, specifically looking at the in-person initial visit and physical address requirements. And, as a country, we can follow Oregon’s example, decriminalizing drug possession and repurposing the funding currently spent on interdiction instead on overdose prevention and connecting people to care.

We have proof of what works. Now is the time for our collective action.