Pa. eases take-home restrictions on meds for people in opioid recovery to reduce clinic crowds

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HARRISBURG — In an effort to limit the spread of the coronavirus, some patients in treatment for opioid use disorder will be able to take home up to a month’s supply of methadone, state officials announced Wednesday.

Methadone is a medication that reduces opioid craving and withdrawal, and is generally delivered in person at a clinic. Individuals can earn take-home doses based on their length of time in treatment. The maximum take-home dose — as regulated by state and federal agencies — had been 14 days.

Nearly 100 methadone providers operate in the state, most serving hundreds of clients, who stand in line or gather in crowded waiting rooms. Such limitations created a high risk for spreading COVID-19, said Jennifer Smith, secretary of the Department of Drug and Alcohol Programs.

The temporary change allows take-home doses for up to 28 days, and lets physicians make the decision about which patients are ready for increased take-home doses.

“We are in an unprecedented circumstance,” Smith said. “We have to ensure our vulnerable population of people continues to have access to medications they need to stay healthy and alive without exposing themselves potentially to the spread of the virus.”

Pennsylvania was able to make the change after federal guidelines were eased Monday. It’s the first of many changes Smith is anticipating in the addiction treatment field. Her agency is scrambling to respond to myriad disruptions caused by COVID-19, from ensuring that treatment facilities maintain proper staffing ratios to allowing telehealth counseling and screening new patients entering facilities.

Many providers said increasing the flexibility of take-home medication was a good first step.

“Liberalizing take-homes is a no-brainer,” said Frederic Baurer, president of the Pennsylvania Society of Addiction Medicine and medical director of a treatment facility in Philadelphia. “Public health concerns demand that we limit everyone’s exposure and promote social distancing in all areas.”

In the past, relaxing regulations around methadone raised concerns about abuse or people’s diverting the medications to be sold on the street. But Baurer said the coronavirus alters the risk-to-benefit equation.

Without reliable access to medication, people can risk relapse within days, he said. At the same time, many people traveling to methadone clinics have other respiratory or immunodeficiency conditions that can put their health in jeopardy should they contract COVID-19.

For Jamie, who lives in Montgomery County, going to her methadone clinic in neighboring Bucks County last week created a lot of anxiety. (She asked that her last name be withheld because her employer and family don’t know about the treatment she receives.)

“I live with my 65-year-old mother and my toddler daughter,” she said. “I don’t want to be carrying any virus back and forth.”

Jamie started methadone treatment when she got pregnant, and it’s been a life-saver, she said. Over the years, she’s worked up to receiving two take-home doses. But with the outbreak, she’ll soon receive closer to 10, she said.

That’s crucial to allowing her to live safely, she said. “I need to be able to work and be a mom and live my life.”

Jamie’s clinic has taken other steps to reduce the spread of the coronavirus. It canceled group therapy, moved individual counseling to the phone, and is only allowing seven clients inside the building at a time.

Allowing patients to take home more doses protects not only those who visit the facility less frequently, Smith said, but also those who still have to come in for daily doses. Fewer patients at the clinic also decreases the demand on staff, some of whom may have to stay home if they’re sick themselves or caring for a family member, she added.

But not all clinics are changing their practices, and the state is not requiring them to do so. Several members of a Facebook group for people with substance use disorder and their family members raised concerns this week about clinics that are not planning to offer longer take-home doses.

Smith said the majority of methadone clinics in Pennsylvania have expressed interest in increasing take-home doses, and she expects clinics will begin rolling out the changes by the end of the week. She estimated that hundreds of patients will be affected.

Pinnacle Treatment Centers, which owns 13 clinics in Pennsylvania that provide methadone services, estimates that the flexibility will decrease crowds in the facilities by 40% to 50%.

Pinnacle is also extending facility hours so patients can stagger their arrival times, and asking patients questions about international travel and symptoms like cough and fever, said Holly Broce, the company’s senior vice president of opioid treatment programs.

Regan Kelly, president of Northeast Treatment Centers, said the organization’s two methadone clinics in Philadelphia — which serve about 650 people between them — have been preparing since Monday to identify patients who might be eligible for take-home doses of methadone, anticipating that the federal government would relax restrictions around the medication.

Kelly said she believes the new policies will be rolled out over the next few days. People who are still using drugs or having “significant adjustment problems” in treatment may not qualify for a take-home dose, she said. “We’re trying to be as generous and broad as we can,” she said.

Earlier this week, the federal Drug Enforcement Agency eased its restrictions on prescribing buprenorphine, another medication to treat opioid use disorder, which often goes by the brand name Suboxone. Previously, physicians were required to do an in-person consultation with the patient before writing a prescription. During the outbreak, that initial consultation can be done virtually.

As the number of coronavirus cases continues to climb, Pennsylvania is also preparing for the possibility of delivering methadone to individuals’ homes if they test positive for COVID-19 and are put into isolation.

“At this point there is nothing off the table in terms of evaluating it for usefulness,” said Smith of the drug and alcohol department. “It doesn't mean we will be able to accommodate everything, but I think everyone is willing to be much more flexible.”

Inquirer staff writer Aubrey Whelan contributed to this article.

If you need help finding addiction treatment, call Pennsylvania’s Get Help Now hotline at 1-800-662-HELP for free guidance 24 hours a day.

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