One photo shows a long line of people standing close together while waiting for methadone at the counter of an opioid treatment program in Minneapolis last Friday. Another shows a crowded waiting room last Saturday at a similar clinic in Winston-Salem, N.C.

These images, collected by an advocacy group, show that many people are having to risk Covid-19 infection to get their addiction-treatment medication — weeks after the federal government relaxed rules that require people to show up at clinics every day to get methadone.

Aimed at reducing the spread of the novel coronavirus, the new rules allow people considered “stable” to take home up to a 28-day supply of methadone under a blanket exception, and people considered “less than stable” to take home up to a 14-day supply. But advocates for people recovering from addiction say compliance with the new guidelines has been inconsistent.

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Methadone patients and staff from more than half a dozen states have sent photos and videos and called with complaints, said Zachary Talbott, president of the National Alliance for Medicated Assisted Recovery (NAMA). About a third of the complaints are from staff. “They’re calling because they’re worried about the patients, and they’re concerned that there is no social distancing,” he told STAT. They’re also worried about themselves, because they have no personal protective equipment.

Talbott received reports from clinics in Massachusetts and Florida that people who had tested positive for Covid-19 were still having to pick up their methadone treatments in person, putting staff and other patients at risk.

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“If supermarkets can enforce social distancing, why can’t OTPs?” asked H. Westley Clark, a psychiatrist and professor of public health at Santa Clara University who formerly directed the federal agency that regulates opioid treatment programs, called OTPs.

“They can,” said Talbott. “They can do it with tape on the floor.”

In the past month, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Drug Enforcement Administration, which together regulate OTPs and the addiction treatments methadone and buprenorphine, eased the regulations for taking home methadone, and allowed new patients to be started on buprenorphine based on a telephone call only. SAMHSA also issued guidance to OTPs for patients quarantined at home.

But some programs have been slow to respond to the crisis. Talbott detailed some of the abuses in a letter sent Wednesday to Mark Parrino, president of the American Association for the Treatment of Opioid Dependence (AATOD), the membership association of opioid treatment programs. A copy was obtained by STAT.

It describes reports from eight states of clinics performing “call-backs” and “medication counts,” requiring clients with take-home doses to come in, which defeats the purpose of the federal rule changes. Clinics with no social distancing protocols still require in-person group counseling sessions and regular attendance — even for people with chronic health problems and lung conditions that put them at increased risk for infection, and for those with confirmed positive tests for Covid-19. At one clinic, infected clients were told that the program could not figure out how to implement protocols for tracking methadone if they took it home.

Most of the treatment programs in the country “are doing it right,” Talbott said of following the new rules. But there’s a “substantial minority of bad actors.”

Among the good: OTPs in New York City, where Covid-19 has hit the hardest and there are 32,000 methadone patients. The programs there — and in the rest of the state — are following social distancing, as required by the state. They have also increased the number of doses clients can take home, but not immediately going from a daily to a two-week supply. Instead they start with two or three days, increasing based on stability.

The New York City Department of Health estimates that almost half of the methadone patients will need to be isolated because of possible exposure via a contact, or an actual infection. This could make it challenging for many to get methadone, unless they have 28 days of doses, pharmacy delivery, or some other way to get their treatment.

The complaints support a letter urging more steps to protect people treated with methadone from Covid-19 and enforcement of the new methadone guidelines. The letter is being circulated for signatures among advocates and treatment experts by NAMA, the Drug Policy Alliance, and the North Carolina-based Urban Survivors Union, and is expected to posted online Thursday.

Notably absent from this sign-on letter is the trade association representing OTPs. But Talbott and AATOD’s Parrino both told STAT that the group takes these problems seriously and is going to investigate the complaints.

Parrino said he is concerned about patient safety, as well as treatment programs’ liability because of the subjectivity inherent in the new rules. “Stable” is not a clinical term, and SAMHSA is leaving it up to the OTPs to decide who is stable enough for 28 days of take-home medications, and who among the “less stable” can get 14 days, he said.

Clark said it’s important to strike the right balance among competing risks. He said social distancing for unstable patients is a better way to protect them from the coronavirus than giving them too many take-home doses. “Handing over large amounts of opioids to anyone puts them at risk, their children at risk, and the community at risk,” he told STAT. “Since we’re dealing with intersecting epidemics, we need to recognize the need for caution.”

NAMA wants the additional steps called for in the letter to remain in force until the Covid-19 pandemic is brought under control. Among these steps are expanding access to methadone delivered by the pharmacy, increasing take-home privileges to the maximum extent, and suspending urine testing.

But many of the other groups that have signed, including the Drug Policy Alliance, want to see the OTP system revamped or even eliminated completely.

  • I go to a clinic in saugus ma. I am not allowed to work, go out to eat, or take my kids to school. Says the government. Today they went from advisory of leaving my house. To a mandatory curfew.
    So now I’m not allowed to go out except to go to my methadone clinic. We’re I stand in line , inside a building, no bigger then my bedroom. An there is 30 other peaple standing on an x , on the floor, 2 FEET apart for an hour at a time. I didn’t get take homes, but my friend who OD in the parking lot of my clinic 2 days earlier. An got narcaned 4 TIMES BEFORE BEING TAKEN BY AMBULANCE TO THE HOSPITAL.. RECEIVED 21 TAKEHOMES. THERE ARE PEAPLE WHO WALK IN EVERY MORNING , FALLING OVER OR EYES ROLLING BACK IN THERE HEAD, TO HIGH TO HAND OVER THERE’ ID. AN THEY GOT TAKE HOMES.
    THERE ARE NO RULES BEING FOLLOWED. I HAVE BEEN AT MY CLINIC FOR OVER A YEAR , AN I HAVE NEVER MET THE DIRECTER IN CHARGE. SO BECAUSE I GO EVERY MORNING AN IM IN AN OUT. AN I DONT HANG AROUND AN SOCIALIZE. IM NOT KNOWN BY EVERYONE I DO T GET TAKE HOMES.
    ITS THE MOST SCREWED UP THING. TBEY SAY DONT LIVE YOUR LIFE , AN GO OUT. DO TO THE FACT YOU COULD GET THE VIRUS OR SPREAD THE VIRUS. BUT YOU STILL HAVE TO GO TO THE CLINIC AN PUT YOURSELF AROUND ALL THOSE PEAPLE. THEN GO HOME FOR THE REST OF THE DAY AN NIGHT. WHERE MY ELDERLY PARENTS LIVE AND MY GIRLFRIEND AND 3 LITTLE CHILDREN.
    WHAT GUIDELINES!!—

  • I am 67 years of age and have been diagnosed as A-FIB. I still have to go to the clinic 6 days a week during the pandemic.
    WHY ???

  • It’s incredibly frustrating how (likely) well-intentioned but paternalistic and parasitic many methadone clinics can be including mine in Boston which some might consider to be less oppressive than most clinics in the US.

    I get all my prescribed medicines from a pharmacy – like most everyone else in the developed world- EXCEPT for my Rx methadone.

    Many people like me who are living with disabilities & chronic health conditions pickup this *same prescribed medicine* at pharmacies once a month as opposed to myself & others who are required to get it daily in person in a liquid formulation.

    Q: Why can’t people like us get all our prescribed medicines in the same convenient way via local pharmacies?

    A:
    -Because of the racist, classist war on drugs & people who use drugs.

    -Because of antiquated OAT (Opioid Agonist Therapy) policies & laws in the US that were crafted with the original intent being to fight crime, “public disorder” & perpetuate the drug war instead of basing health policy for OAT (methadone therapy specifically here) in the realm of healthcare and human rights.

    When the COVID19 pandemic comes to an end & we’re left with again tackling the overlapping overdose, drug contamination, HIV, Viral Hepatitis, homelessness pandemics we really should put a lot more work into overhauling the antiquated, unscientific & lethal barriers to all evidence-based medication therapies & healthcare policies and push hard for universal pharmacy access to methadone & so the other invaluable agonist medicines for anyone who needs them.

    No one should be punished or be dehumanized daily for taking a medicine that they need.

  • My clinic in Kentucky is still making pts come in 3 to 4 times a week even though the Clinic considered them stable enough to get takehomes before the virus! Also when getting our dose adding water to it is still accessible to everyone so we’re all touching the water jug. How is that practicing safety measures!! No one will do anything about it. I have COPD AND ASTHMA and my husband has severe lung issues so every Time I go.. I’m exposing him. He would not live if he gets this..

  • Why are people still on methadone anyway? With suboxone or subutex out there , it doesn’t make sense . You can get high on methadone, kind of defects the purpose.

    • Obviously suboxone doesn’t work for everyone. And getting high on methadone is absolutely incorrect. This is why methadone has such a bad stigma because people don’t do enough research thats out there!!

    • So many uneducated know it alls. You dont get high off of Methadone Period!!People make me ill I am on methadone and always having to defend myself to those who don’t know what they are talking about im just sick of it all and dont care what you think.Its Suboxone and Subutex that is abused your dose is not controlled they give 30 days worth at a time. I know people shoot it up or take more than they should or just sell it thats whats really being abused just like heroin is no difference I know plenty of addicts being a recoverd one myself and Methadone saved my life without getting high off it !!!!

    • Ed, you can get high on any of those. Why do you think Suboxone is bought on the streets? It’s getting to a stable dose and maintaining it until you feel stable enough to start detoxing, slowly. Slowly so the brain stays wired to recovery and not addiction.

    • Yeah you can get high from methadone I was on a really high dose. 180mg but anyways it doesn’t take that much to get not feel pain with 100 mg dose. I take 125 now I got down to 75 and started to relapse so I decided to go back up and for those who say I don’t know what I’m talking about I’m 32. I’ve been going to the clinic since I was 17. My clinic wouldn’t give take home if you had a dirty until 2 weeks ago. You had to come in 3 times a week now I only have a week of take homes.

  • They can do it as they do it in Europe. Patients go the pharmacy closest to them to drink the methadone. This would spread them out. Al 32,000 won’t have to go every single day to the same small building with no windows.

    • You know that would be really good the clinics are a waste of time and money neither curing or even treating the addiction and they do nothing for the community.

  • There’s only one Methadone clinic in Winston Salem. The clinic is WSCTC. Their a Acadia Healthcare company.

    • No there is more then just one clinic in Winston salem! You have insight which is downtown and wsctc which is on Hawthorne rd and I’m sure there is a couple more

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