Patients Can Take SUD Medications Home Due to COVID-19

People receiving treatment for opioid use disorders (OUDs) must often visit their clinics every day to receive their medication. In light of the coronavirus (COVID-19) pandemic, however, such daily travel may prove not only difficult, but dangerous.

To help ease the burden on patients and physicians, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued guidance in mid-March allowing some patients receiving treatment for OUD to take a 28-day supply of their medications home.

All states may now make a blanket request to allow opioid treatment programs (OTPs) to provide stable patients with four weeks of medication to take home, according to SAMHSA’s guidance. Those who are not considered stable “but who the OTP believes can safely handle this level of take-home medication,” the guidance states, may receive two weeks, or 14 days, of their medication.

SAMHSA first published the guidance on March 16, then updated it on March 19. The initial version allowed only states that had declared a state of emergency to make a blanket request, while OTPs in other states could make requests for their own clinics. On March 19, SAMHSA updated the guidance to apply to all states regardless of whether they had declared a state of emergency.

In its updated guidance, SAMHSA did not define the term “stable,” but in the March 16 version, it stated that programs and states should use “appropriate clinical judgment and existing procedures to identify stable patients.”

Patients with OUD are often treated with methadone, buprenorphine, or, in some cases, the opioid antagonist naltrexone, explained Smita Das, M.D., Ph.D., M.P.H., a clinical assistant professor of psychiatry and behavioral health sciences at Stanford University School of Medicine and a member of APA’s Council on Addiction Psychiatry. “These are lifesaving treatments that are essential to the care of people with opioid use disorder,” Das told Psychiatric News in an email.

When patients initially start OUD treatment with such medications, they must make daily trips to their OTP to get their dose, she explained. Over time they can take some doses home, but it can take months or years of stability, and the practice is tightly regulated.

In 2015, according to SAMHSA, there were 350,000 patients receiving methadone from OTPs daily.

“Patients often have to take public transit to get to the clinic in the morning, wait in line, get dosed at a window, and then go on with their day,” Das said. “Some patients may have medical conditions or may be older, putting them at increased risk of severe illness and death if they contract COVID-19.”

The Drug Enforcement Administration (DEA) also announced in a March 16 letter that it has eased restrictions on who can dispense medications for patients who are quarantined due to the coronavirus. During such times, treatment program staff members, as well as law enforcement officers and national guard personnel, can deliver the medications to an approved lockbox at patients’ homes. The change applies only as long as the country’s public health emergency, declared on January 31, lasts. Typically, only licensed practitioners can dispense or administer medications to patients.

“Using public transit daily and going to a full waiting room may put everyone at risk,” Das said. “In light of COVID-19, we need to consider the health and safety of those patients and the community.” ■

“Opioid Treatment Program (OTP) Guidance” is posted here.

The DEA’s letter is posted here.