Covid-19 Shifts More Methadone From Opioid Clinic to Home

More patients recovering from opioid addiction may be eligible to take methadone and other treatment drugs at home instead of at clinics during the coronavirus pandemic thanks to relaxed federal rules.

The Substance Abuse and Mental Health Services Administration this week relaxed patient eligibility regulations for take-home medication like buprenorphine and methadone and how much medication can be brought home at one time.

People in medication-assisted treatment for opioid use disorder typically must be physically present at methadone clinics or other treatment centers to get their daily doses. Take-home options have been strictly regulated and based on specific recovery timetables.

But the loosening of requirements means patients will be able to get up to a month’s supply of either drug to take at home if a doctor says their recovery is stable. For some patients with less recovery time under their belt, there’s an option to get a two-week supply based on a doctor’s recommendation.

The shift is part of a broad public and private effort to prevent the spread of the new coronavirus. Physical distancing, cutting down on crowds, and curbing public transportation use are all necessary to prevent the virus’ spread, health officials say.

That’s difficult in clinic settings, where long lines and close contact are common as people wait for treatment. Many patients also may have underlying medical conditions stemming from a history of substance abuse, elevating their risk of contracting the virus and spreading Covid-19, as the disease caused by the virus is known.

“It’s a perfect storm of what you do not want during a public health epidemic,” said Jocelyn Guyer, managing director of Manatt Health, who has been helping states with their coronavirus responses.

Before March 16, exemptions to allow individuals to take their medication home had to be sent to state and federal officials on a patient-by-patient basis, and take-home supplies were tied to recovery timetables.

Filing paperwork for individual patients “can be very time consuming and is not nimble when faced with a public health emergency such as the one we find ourselves in,” Yngvild Olsen, medical director for an opioid treatment provider in Baltimore said. Now that federal expectations for paperwork are less demanding, it’s up to states to decide exactly how they’ll take advantage of the change, she said.

States Get Creative

Home methadone delivery, and options for picking up medications in bulk, are among the tools at states’ disposal to stop the spread of coronavirus while not exacerbating the country’s opioid epidemic.

Some acted even before the federal rules relaxed. Indiana’s health department paired with a private company to make take-home lock boxes for medication. Patients can pick up a lock box at their local treatment center, get a code to open it, and then take home their extended supply of methadone or buprenorphine. Representatives for the program couldn’t say when the boxes would be available.

“Doorstep” deliveries of methadone and buprenorphine have been suggested in states like New Jersey, Ohio, and Washington for patients who are quarantined because of Covid-19 or are older with severe health issues.

Overdose deaths are a concern for Olsen and other providers, though. Not only is there a risk that drugs used in medication-assisted treatment may be diverted, but they could also cause potentially dangerous side effects in patients with Covid-19 related respiratory symptoms, Olsen said.

As a precaution, Maryland officials are using federal grant money to buy naloxone—the drug that reverses opioid overdoses—to give patients along with their take-home medication, Olsen said. Indiana is putting naloxone in their take-home lock boxes, too.

When Meds Can’t Go Home

Patients who aren’t stable enough for at-home medications will still have to go to treatment centers. States are encouraging the facilities to follow strict protocols, including separating patients that are coughing or have any Covid-19 symptoms, and using face masks, gloves, and other protective equipment.

With supplies running short, some providers are worried about not having protective gear because clinics may not typically stock what’s recommended to curb coronavirus spread. Opioid treatment programs would have masks and gloves on hand but not other types of personal protective equipment that are typically found in hospitals, according to Olsen.

Maryland officials contacted Olsen this week with an offer of supplies coming in from federal stockpiles. But until they arrive, providers will be faced with a difficult choice, Olsen said.

“Ethically, what do we do when somebody screens positive and we don’t have the appropriate supplies to protect them and also protect our staff?” she asked.