Here’s another lesson from the COVID-19 pandemic: Easing restrictions on methadone, the oldest and most stigmatized drug for treating opioid dependence, seems safe.
Last spring, as the coronavirus closed the country, the government told methadone clinics that they could allow stable patients to take their medications at home unattended.
Early research suggests that this did not lead to a spike in methadone overdoses or illegal sales. And the telephone consultations, which were followed by taking home doses, worked better for some people, helping them to recover and get on with their lives.
US health officials are studying the changes, their impact and how they can be continued.
Since the 1970s, methadone treatment has been governed by strict rules requiring most people to line up and take liquid medicine, sipping it from small cups, under the supervision of clinic staff. Only long-term drug users were allowed to take home more than the daily dose.
Scientists are now gathering information to subject these never-scrutinized rules to scrutiny.
“It took a pandemic to change the climate and allow us to study it,” said Dr. Ayana Jordan of Yale University School of Medicine, which is among researchers looking at changing methadone rules. “If we remove these rules after COVID, it will be devastating.”
More than 400,000 people in the United States receive methadone as part of treatment for addiction to opioids such as heroin, fentanyl and pain relievers. Methadone, itself an opioid, can be dangerous in large quantities, but when taken correctly, it can stop drug cravings without causing a high. People can stay at work and work to rebuild their lives.
Scott Mancini, 58, a retired truck driver from Providence, Rhode Island, has been taking methadone for heroin addiction since 1989. Before the pandemic changed, Mancini, as a longtime rule-abiding patient, could take home a six-year-old. a daily supply requiring a weekly stop at the clinic.
“You are connected,” Mancini said of the old system. Now with a 28-day supply, he can enjoy a long hike or family visit.
“It worked really well for me and a lot of other people,” Mancini said. “I think it’s time to rewrite program rules across the country because the rules haven’t changed in years.”
Not all methadone clinics have relaxed regulations, but Rhode Island’s oldest methadone program, CODAC, of which Mancini is a patient, jumped at the opportunity to use telephone counseling and give more home doses. In a patient survey conducted by Brown University, most people said telephone counseling was helpful.
“We learned two things from COVID,” said CEO Linda Hurley. “There is no need to severely restrict recruitment opportunities, and telehealth works.”
Because of the way opioids work on the brain, addicts get sick if they stop using them. Withdrawal symptoms can feel like the flu with cramping, sweating, anxiety, and insomnia. The cravings can be so strong that relapses often occur. Methadone relieves these symptoms.
The idea behind the Nixon era rules was to prevent illegal street sales and overdoses.
“I understand this concern, but there are ways to address these issues,” such as urine screening to make sure patients are taking methadone, said 37-year-old Lina Chavez from Pleasantville, New Jersey.
In accordance with pandemic rules, she now receives take-away methadone at the John Brooks Recovery Center for five days. Working to become a peer support professional, she also distributes donated food, toothpaste and other items to homeless people.
Rutgers University plans to analyze health data in New Jersey for an increase in methadone overdoses. In interviews with researchers, New Jersey methadone providers support relaxed take-out rules, Rutgers researcher Stephen Crystal said.
People who live far from clinics or have full-time jobs are particularly burdened with the daily commute to monitor their dose, Crystal said.
When the government eased restrictions, it said stable patients could receive methadone at home for 28 days, while less stable patients could receive 14 days. The clinics were allowed to find out which patients were suitable; many relied on their experience and previous government criteria, such as length of treatment and lack of criminal activity.
“HHS is looking into change and how to keep it going,” said Miriam Dolphin-Rittmon, Assistant Secretary for Mental Health and Substance Use.
Meanwhile, a new federal regulation that has just entered into force will expand the use of mobile vans to deliver methadone therapy to rural and hard-to-reach areas. Now there are about a dozen of them.
“Methadone vans would be a good way for states to spend their money settling opioid lawsuits,” said Beth Connolly, who leads the Pew Charitable Trusts drug prevention and treatment project. As early as next year, the states may receive money from settlements with manufacturers and distributors of prescription drugs.
The US government said last month that overdose deaths rose to a record 93,000 last year, with over 60% of these attributable to fentanyl.
According to Allegra Schorr, who leads a coalition of drug dependence treatment providers in New York, the pandemic has made it possible to take more doses of the drug at home. “It worked. Why would you just go back to how it was? “