Your partner in patient care

We help patients on prescription opioids with diagnosed or undiagnosed substance use disorder, get the non-judgemental scientific treatment they deserve from the comfort of their home.

Concerned about your patients' opioid use?

Whether your patient has developed a tolerence for their opioid medication, or you suspect potential opioid abuse - effective evidence-based treatments now exist to help them get better.

Many treatment options exist for patients using opioids. The right one will depend on several factors, such as:

  • How long has the patient been using opioids, heroin or other opiate drugs
  • The amount and frequency of the patient's substance use
  • Whether they use alcohol or other drugs in addition to opioids

Levels of Care according to the ASAM criteria

We specialize in Medication-assisted treatment, an FDA approved outpatient treatment that uses anti-craving medicine such as Buprenorphine (Suboxone) or Methadone — along with therapy and support — to help address issues related to opioid dependence. Including withdrawal, cravings and relapse prevention.

These medications are opioids themselves. Hence, they can fulfill a person’s cravings and stop withdrawal symptoms. The key is that they do this in a safe medical setting, and when taken as prescribed do not produce the euphoric high that opioids do when they are misused. By doing this, an opioid user significantly reduces the risk of relapse, since he/she doesn’t have to worry about avoiding withdrawal anymore.

The research is clear - Medication-assisted treatment works.

Various studies, including systematic reviews of the research, have found that medication-assisted treatment can cut the all-cause mortality rate among addiction patients by half or more. That’s why the biggest public health organizations — including the Centers for Disease Control and Prevention, the National Institute on Drug Abuse, and the World Health Organization — all acknowledge medication-assisted treatment’s medical value. And experts often describe it as “the gold standard” for opioid dependence/addiction care.

One less thing to manage

Managing opioid dependence / addiction can be quite challenging, especially with an already full practice. With evidence-based treatment pathways, delivered by licensed physicians, over telemedicine - we can help.

Expert Diagnosis

An expert, licensed physician can diagnose your condition and create an individualized treatment plan over a 60 minute virtual visit. Learn about the type of care and the level of care you need (e.g: outpatient, intensive outpatient, residential etc.) so you can take the right next step.

Opioid Tapering

Through virtual visits, we can decrease your opioid dosage by a small amount every month (i.e a taper) and eventually try to get you off of your opioid medication completely. A taper has been proven to work more effectively than quitting cold turkey, and can be a good option for some people.

Switching to Buprenorphine (Suboxone®)

In 2 - 3 months of virtual visits (and one in-person visit), we can help you stop using your opioids and switch to Buprenorphine - a FDA approved initial line of treatment for patients diagnosed with opioid use disorder. This includes helpful community resources and referrals to other providers (e.g pain management, therapy, etc.) as needed.

If your patient needs a higher level of care than what we can offer, we will refer them to an appropriate provider.

Why Bicycle Health?

Evidence-based Treatment Over Telemedicine

Research proves that a treatment such as ours (Medication Assisted Treatment or MAT), is the best line of treatment currently available. When delivered over telemedicine improves patient adherence and retention in treatment.

Fits in your workflow

Simply refer patients using a secure online form or by handing them our postcard, and stay in touch with us over the phone / email / fax.

Affordable

Patients can use any insurance to pay for medications and lab tests. Physician visits are covered under some insurance plans as well. They might also qualify for free treatment as well through a California state grant.

Take the next step

If you have patients taking prescription opioids or using them recreationally, please reach out.

Make a referral

Frequently Asked Questions

If you have any questions that aren't answered here, please reach out: info@bicyclehealth.com.

How does your treatment work?

We help anyone on chronic opioids reduce the risk of using opioids and potentially end their opioid dependence. Here’s how it works:

  1. First visit is in person: Patients see one of our providers in person at one of our locations. The provider spends about 1 - 1.5 hours with the patient understanding their health history, mental health, substance use history and coming to a substance use disorder diagnosis, if appropriate. The provider then starts the patient on a week’s prescription of Buprenorphine/Naloxone. The patient also gets education on how to start their medication at home.
  2. Phone check-ins in the first week: The provider calls the patient every other day in the first week. To check in on them, making sure they are taking their medication correctly and helping them manage any withdrawal symptoms using over the counter or prescription medications.
  3. Follow ups over video calls: The patient has scheduled follow up visits with their provider, all over secure video calls. Follow ups are weekly in the first month, every other week for the next 2 months and every month thereafter, until needed. Patients get a prescription of Buprenorphine/Naloxone until their next visit at each follow up visit. Patients also need to have completed a urine drug screen before every follow up visit.
  4. Counseling and Mental Health: Every patient is connected to community resources for group support and counseling. If needed, patients are also connected to psychiatrists for 1-1 mental health care.

How much does your treatment cost?

It depends.

  • Free: Our treatment is covered by a state grant for everyone in San Francisco, Alameda and Contra Costa county regardless of their affordability or insurance status. It’s also free for people with affordability issues in Solano, Santa Clara, Fresno and neighboring counties.
  • Covered by insurance: All medications and labs are covered by all insurance companies. Our medical fees are currently covered by Blue Shield of CA. We have submitted our applications to get covered by other insurance plans - just waiting to hear back. For patients where our medical fees aren’t covered by insurance, we charge $20 for the first visit and $75 for every follow up.

What insurance plans do you take?

We currently accept Blue Shield of CA. We have submitted our applications to get covered by other insurance plans - just waiting to hear back. We can also provide free treatment for many patients through a state grant.

Who are your providers?

We currently have 3 providers:

  1. Dr. Anusha Chandrakanthan: Dr. Chandrakanthan graduated from Stanford University’s Addiction Medicine fellowship. She has experience with a variety of patients with addiction including poly-substance abuse, complex co-morbities and homelessness.
  2. Dr. Kanwal Qidwai: Dr. Qidwai graduated from Kaiser Permanente’s Addiction Medicine fellowship. She has experience in treating patients in the ED, inpatient, outpatient and intensive care settings. She also has training in pain management, and intensive inpatient and outpatient psychiatry.
  3. Dr. Ken Starr: Dr. Starr is a Board Certified Addiction Medicine Physician in San Luis Obispo County where he runs the Ken Starr MD Wellness Group. He specializes in all levels of Outpatient Drug and Alcohol Treatment. The clinic provides Medication Assisted Treatment as well as detoxification and counseling programs.

Where are you located?

We can treat anyone in California. 99% of our treatment happens over phone and video calls - hence patients can be anywhere while they are getting treatment. When patients do need to come see (their first visit), we see them in the following locations:

  1. San Francisco: 350 Townsend Street, San Francisco, CA. Close to caltrain. Unmarked, private and confidential room. No waiting room and no other patients.
  2. Arroyo Grande: Ken Starr MD Wellness Group, 107 Nelson Street, Arroyo Grande, CA.

Why telemedicine?

Telemedicine allows us to help patients in the most convenient, confidential and affordable way. Here’s how:

  • About 50% of people with an opioid use disorder are working in full time jobs. Telemedicine allows them to stay in treatment without the hassle, time spent and potential financial loss of driving to a clinic.
  • When someone is abusing opioids, they might not want to bump into other opioid abusers. Telemedicine allows us to always have a one-on-one private relationship with our patients.
  • People who might be in a visible, public, or otherwise leadership role don’t like to be seen walking into a treatment center. Telemedicine allows us to maintain complete confidentiality.
  • Telemedicine allows us to keep costs low and pass the savings along to our patients and customers.

What kinds of patients do you accept?

We accept all patients on chronic opioids. If a patient is using opioids for chronic pain, being on Buprenorphine will decrease the risk of overdose and addiction. We can also diagnose whether the patient is misusing their opioids and start them on the right treatment for that.

How do you monitor patients?

We expect patients to do a urine drug screen before every visit. We are connected to all labs under LabCorp and Quest. Hence patients can always find a convenient lab near them to do this test. All the lab tests we order are covered under insurance.

What happens when patients have a positive urine drug screen (i.e are using recreational drugs)?

We look at positive urine drug screens for illicit/recreational substances as a point of conversation with a patient. We use motivational interviewing and other skills to help patient set goals around decreasing/stopping their recreational substance use. For repeated positive urine drug screens for recreational substances or for urine drug screens negative for buprenorphine, we implement some contingency management strategies but will continue to work with the patient.       

Are you pain management?

While we don’t do pain management, we can help guide and refer to appropriate physicians.

Do you do any counseling?

At the moment, we do not have any counselors on staff. However, we connect every patient to community resources for counseling and group support. We monitor their adherence in every follow up visit and help them find the right counseling/support structure if we notice poor adherence.

Mental health is important in any addiction treatment plan. How do you help your patients with that?

For patients that need mental health care, we refer them to a psychiatrist with expertise in dealing with patients on opioids. We work in a coordinated fashion with this psychiatrist to ensure patients reach their goals.

What happens if someone doesn’t pick up your call?

We understand that motivation can be fleeting, especially for patients who are seeking substance use treatment. We will try to reach them multiple times over the course of 2 to 3 weeks in an attempt to engage with them. However, if we are unsuccessful but the patient would like to come back at any point, our doors are always open.

What happens if a patient is having an emergency and needs to be seen?

We are just a phone call/text message away. One of our providers will reach out to the patient in 24 hours and direct the patient appropriately.

What about people with other Substance Use (like Alcohol, Benzos, etc.)?

At this time, we are seeing patients with Opioid use disorder. We understand that many of them might have other co-occurring addictions, such as benzos. While we are not seeing patients with alcohol use disorder, we will work with the patient and PCP to help taper benzos if needed.

Do you also prescribe Naltrexone?

Absolutely. We offer all treatment options to a patient and let them decide what suits them and their lifestyle best.

What outcomes do you track?

We track the following outcomes based on FDA’s guidance for effectiveness of Medication-Assisted Treatment.

  1. Retention in treatment: Percentage of patients that are still in treatment with us at the 3 month, 6 month, 9 month and 1 year mark (based on medication adherence)
  2. Change in disease status: Percentage of patients in Opioid Use Disorder remission at the 3 month, 6 month, 9 month and 1 year mark (based on DSM-5 criteria)
  3. Change in drug use pattern: Six month abstinence from original drug of choice at the 6 month, 9 month and 1 year mark (measured by urine drug tests).
  4. Change in Emergency Room utilization: Percentage of patient who went to the Emergency Room for any condition related to their opioid dependence (measured with data from partner emergency rooms).
  5. Cost savings for the health system: Decrease in total health care utilization by our patients at the 1 year mark (measured by the amount of money the patient’s insurance company spent on outpatient care, inpatient care, emergency room care, medications and other costs).

How do I make a referral to you?

We prefer that you make a referral through your EMR. Simply send a referral to either Bicycle Health or Dr. Anusha Chandrakanthan. If this doesn’t work, we are happy to help you set this up (it’s very easy).

You can also make a referral by filling this secure form online: https://bicyclehealth.com/make-a-referral.