In cities across the country, morning is peak time at almost any opioid treatment program. The line stretches from the front counter to the back door as patients wait to get their daily dose of methadone. It’s an absolutely essential gathering, but one that runs counter to containing the Covid-19 outbreak.

Efforts by health systems and governments to contain the spread of SARS-CoV-2, the novel coronavirus that causes the disease, have revealed gaping cracks in our nation’s public health and safety net infrastructure. The virus appears to have an outsized effect on vulnerable Americans. We have already seen in a Seattle nursing home how quickly the virus travels in close quarters. It is likely to do the same among the homeless and those who are incarcerated. Missing from the national discussion has been another vulnerable group: patients like ours with opioid use disorder.

Despite ongoing public health efforts, the opioid overdose crisis does not appear to be slowing down. The emergency of Covid-19 could worsen it if we do not preemptively develop and implement response plans.

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The Centers for Disease Control and Prevention currently recommends social isolation as a key measure for individuals to prevent getting infected and to curb spreading it to others. Many patients taking medications to treat their opioid use disorder — methadone or buprenorphine — aren’t able to stay home because of government regulations that limit how these medications are prescribed and dispensed.

In the United States, methadone can be dispensed only at highly regulated and monitored opioid treatment programs. There are more than 1,250 such programs across the country that treat more than 350,000 people. Strict rules require most of the people to show up at the program every day to get their dose of methadone. A single opioid treatment program may see thousands of patients a day, a scenario that could foster the spread of the coronavirus.

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How will these patients stay safe? Although the Substance Abuse and Mental Health Services Administration (SAMHSA) recently released a guide for opioid treatment programs dispensing methadone during the Covid-19 outbreak, implementing the guidelines is contingent on state regulations and falls short of what is needed.

In the past, experts have called for updated regulations that allow office-based methadone treatment, but nothing has budged. There is now an urgency for this change to occur.

In the setting of an outbreak of a highly contagious infectious disease, requiring patients with opioid use disorder to come to an opioid treatment program to get the medication they need to fight their addiction could have two negative outcomes. First, individuals will continue to come and get their medication even though they have symptoms of Covid-19, possibly exposing other patients passing through the program and the medical staff caring for them to the virus. A second possibility is that individuals will not — or cannot — come because of infection, leading to missed medication doses followed by opioid withdrawal and increased risk of recurrent drug use and overdose.

Both outcomes would harm our patients. And if SARS-CoV-2 continues to spread, it will not be a matter of whether an outbreak will occur at an opioid treatment program, but when.

To reduce patients with symptoms from infecting others, outpatient clinics and urgent care centers have ramped up the use of virtual visits and insurance companies are expanding coverage for them. Federal agencies could mirror this approach by changing policies regarding methadone during a state of emergency. They could make it possible for clinicians to use virtual visits to evaluate patients, allow all patients to take additional doses home, make it possible for surrogates to pick up doses when someone is ill, or deliver doses to those unable to come to the clinic.

The SAMHSA guidance includes some of these options for individuals who are quarantined or those with known exposure or symptomatic infection. Yet given what is known about community transmission of infectious disease and the need for social distancing, limiting these options just to those with likely or known infection won’t be enough to limit spread.

In Canada, pharmacies can dispense methadone. Federal agencies could allow U.S. pharmacies to temporarily do the same if an opioid treatment program shuts down due to an infectious outbreak or other unforeseen circumstance.

Natural disasters and emergencies can significantly disrupt manufacturing and distribution. After Hurricane Maria ravaged Puerto Rico, shortages of medically necessary intravenous fluids occurred in the U.S. The global spread of SARS-CoV-2 will likely lead to disruptions in drug and medication supply chains from outside the United States. For individuals with opioid use disorder, not being able to get a dose of buprenorphine or methadone could result in withdrawal and return to substance use. Government agencies and systems must act now to ensure adequate supply of lifesaving medications for opioid use disorder.

In case of quarantine, patients have been advised to “stock up” on their medications, an option that isn’t available to those with prescriptions for controlled substances like methadone. Regulators must consider granting patients on controlled substances longer prescriptions in preparation for shortages or challenges with accessing the health care system.

During unprecedented times such as a global pandemic, established protocols need to be modified to best serve patients and limit potential harms. Patients with addiction and their doctors deserve clear guidance about how to stay safe during such times.

Ximena A. Levander, M.D., is an addiction medicine and clinical research fellow at Oregon Health and Science University in Portland, Ore. Sarah E. Wakeman, M.D., is an addiction medicine physician at Massachusetts General Hospital in Boston, medical director of the hospital’s Substance Use Disorders Initiative, program director of the MGH Addiction Medicine Fellowship, and assistant professor of medicine at Harvard Medical School.

  • The methadone clinics are not so ppl can get high I have successfully gotten sober 8 years bc of methadone. Just bc some ppl abuse drugs doesn’t mean all do and further more methadone doesn’t get u high all it does is make U fall asleep if u take too much. The ppl getting high are ppl mixing drugs

  • I have called my doctor , my pharmacy and my insurance company and because I have mental health issues some of my medication are controlled substances. I will be out of medication soon and I am slightly sick and none of them seem to care. They have all told me the same thing and that is go into my doctors office and get my refills. I live in southern Louisiana and no one is helping people like me out at all.

    • whats the issue. wear a cover over your face and wash you hands after and youll be fine. they told you to come in and get them. not everybody who is paranoid and not symtamatic is gonna get special treatment. the people who step up for themselves will be the ones will the least amount of disruption in there medication situation. if you do get you refills, treat them as you might not get more.

  • Who can i contact to try and help with this methadone clinic problem? More voices heard the better.

  • It is a understatement that Methadone treatment is restrictive. The government is worried that clients will sell their doses. If you have take-home doses, you constantly have call backs so they can make sure you are taking as directed. I have lost mine due to being out of town like 1400 miles from home onetime and in the hospital another time. I can assure people that most Methadone users would never sale their doses. They may take some extra on a bad day, but running out is a HUGE No No. one day no problem, but 2 days or more you would do once. The withdrawal symptoms are horrible and last forever. I quit last December after losing takehomes, in January I was waiting on them to open the door the first day they were open after New Years. I also have seen a sharp rise of older people going to clinics, as they have no choice after their Dr on pain clinic dismissed them. They are physically dependent as are addicts. If their insurance won’t pay for thousand dollar injections or they refuse the shots, out the door they go so we are all in the same boat whether we started with a Prescription or buying on the streets. In this C-19 crisis we need to call our state and federal Senators Representatives and ask them to please change the rules so we all can get the Meds we depend on. They can stager pickup times and days, and have a lot of call backs that are scheduled so they can monitor our usage and reduce diversion. If we come up short or refuse to come in, they can terminate our treatment or dose us down and dismiss us from the program. So please contact your lawmakers and ask for change.

  • It calms my nerves (if only very slightly) to see medical professionals caring about us people that need to rely on going to a methadone clinic. I have been extremely nervous about this whole thing for the past couple of weeks. I’m not really getting any answers at my clinic. Does anybody know who to contact in the government about this?

  • It is not surprising these caring individuals did not even mention the people with chronic pain. Sites like this along with the rest of corporate media always conflate the two issues, in order to dehumanize people with long term intractable chronic pain. People who are already sick, now have to make multiple trips to pharmacies, and extra trips to medical appointments, due to various state laws, restrictions, lack of stock, and useless over regulation.

    None of the restriction on legitimate pain patients, which include physicians no longer treating pain, has had any beneficial effect on the number of people dying from illicit drugs.

    This country was in an Epidemic of Despair, before the Corona Virus, and sites like this misreported factual data, conflated terms, and misled the public on the extent, in order to protect the profiteers. Big pharma instructed their minions, to demonize sick people, because it is profitable. Not one of the clever content creators at this site noticed that lots of Americans were dying, and that medication assisted treatment, was only allowed after they had a brand name product. They took old medications, repackaged them, and jacked the price up.

    This sudden concern about the failing and broken system, and how it will effect people with addiction, is too little too late. Even worse, a lot of the physicians that are administering these programs are in their 70’s and 80s.

    • Branwen – well stated! I’m 64 yrs old, after a decade of spinal surgeries and implants oxycodone had been the only source of relief for chronic pain. Due to the medical imperative to remove patients from oxy, my dr. has switched me to methadone. Methadone has been less effective with worse side affects. All I wanted was to live whatever is left of my life in peace. Methadone is no way for me to live. What is wrong with oxy in a situation like mine when i’ve never abused it over 8 years of prescriptions? Real patients are disregarded.

    • The reason they can’t or won’t so anything about chronic pain patients is because pain is dependent on each person and not scientifically measurable. And there’s also physical pain, and emotional pain and trauma that can blur the lines and overlap one another. Trauma both physical and mental is meant to be dealt with and I know that their are physical pains that are treated with pain meds and get people hooked which actually makes people more sensitive to pain. There is a reason in other countries many issues are treated with diet, exercise, chiropractors, yoga, PT, acupuncture, etc… and it is because pain meds shouldn’t be used long term. We got put into this mess by people who knew better in Big rally only a few ways out of Big Pharma, and Drs who received kick backs. There is Only a few ways out of this mess. Go back to the olden days where people see pharmacists and drugs are decriminalized so people can blot out their pain anyway they see fit without risking incarceration and they accept the risks that come along with it, which is true legal freedom but comes with addicts being given the same rights. Or there is a complete shift away from instant gratification methods in the US and we allow those that are physically injured to live a life where they do not have to work which drives a lot of people to continue to need instant gratification and do not care for their bodies, or are dealing with the consequences of when they choose not to. Neither of which are what most people I know who have chronic pain want.

  • Unfortunately it’s not just about the risk of using. Withdrawal from methadone is a very long process taking up to 6 months for the worst of it to be over. That’s a human unable to function on their own for 6 months. These people have jobs, children home from school, people they need to take care of. If something happens and they are unable to get their methadone they have no choice but to use anything that will allow them to function. It’s either find a way to function or send their own children off to someone else so they can be taken care of for 6 months by someone who can function.
    It’s not really about drug use, it’s about the need to function, especially in these scary times.

    • Same could be said for forgotten chronic pain patients like myself who have been force tapered to ineffective doses and forced to stop it all together but then again its not

  • Thank you very much for your concern for those of us in this current situation. It’s something constantly on my mind as well as those who are in the clinic also. The risk we put ourselves in everyday as as well as the concern for our medication WHEN things become out of our control. Living in Orlando and seeing the parks closed is unreal! We must not be naive to think our clinic will remain open. The administration has not exactly been 100% precise on the exact protocol on the this extreme ordeal other than they will send out a group text message informing the patients of the clinic being closed. Yet where do we go from there??!! Thank you again for bringing light to a huge amount of the American population that so many tend to forget about.

    • They need to make decisions and quickly. This morning things going a little crazy at my clinic. We had to wait outside now that only 10 people can be in the building at once. Also people that have take homes got 2 weeks worth of bottles but we were told daily dosers still have to come everyday. This doesn’t seem like a good idea. Theres so many people and you think 50 people standing in line outside is that much better than standing in the building. People were cold and aggravated because noone could give us much info besides only 10 people at a time. And that if things change they will call us. Everyone should get 2 weeks of take home in my opinion.

  • The laws regarding pain mediation need to be changed immediately also, if only temporarily, as the highest risk patients must now go where they’ve been told not to go-into clinics-to get refills. Hospice, cancer, you can isolate and go into withdrawal and severe pain, or go get sick and probably die. Been asking for exception protocol—none to date. Call officials

    • All controlled substance laws need to be suspended for the duration of the crisis to avoid further clogging system with heart attacks and strokes from unrelieved pain, etc., and minimize spread. Leadership.

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