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As the number of COVID-19 cases in the United States surpasses 160,000, the impact continues to affect almost every part of daily life for Americans. Thousands of businesses have closed, leaving more than 3 million people filing for unemployment benefits as of March 26, 2020. All Americans are advised to practice social distancing, with many states like California, Colorado, and New York enacting mandatory stay-at-home restrictions. It is a difficult time for everyone, but some groups are facing another set of challenges. People who rely on opioid treatment providers typically go to a facility every day to receive a dose of methadone or buprenorphine to avoid withdrawal and slipping back into their opioid addiction. What are the options when people are encouraged to stay home, but need a daily and potentially life-saving medication?
Opioid treatment programs (OTPs) are systems put in place by the government to provide treatment for opioid dependence. These programs provide medication-assisted treatment, as well as counseling. The FDA approved medications that OTPs provide are methadone, buprenorphine, and naltrexone. These 3 medications are used to treat opioid addiction by preventing withdrawal symptoms and preventing relapses into drug abuse. The goal of offering these medications is to reduce criminal activity, the use of illicit substances, and the spread of infectious disease. they also focus on improving quality of life and helping people with family relationships, community involvement, and skills that may lead to or improve employment.
Hundreds of thousands of Americans make use of OTPs, working to improve themselves, but most of them must travel to a facility every day to receive a dose of their medication. These medications are essential medicines, so OTPs will remain operational during the COVID-19 pandemic. However, for at risk populations, traveling to a facility every day could increase their risk of becoming infected and potentially spreading the disease.
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For those recovering from an alcohol or substance use disorder, the social distancing measures put in place have presented a number of challenges in holding onto sobriety. Services like Alcoholics Anonymous’ Online Intergroup and Virtual NA are providing a way for people to participate in online 12-step meetings. The meetings that are still being held in person are taking precautions such as avoiding hugging, touching, and shaking hands with other members, as well as suspending food hospitality. OTPs are adapting some of these practices as well as creating new guidelines.
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The Substance Abuse and Mental Health Services Administration (SAMHSA) released guidance for OTPs, stating that stable patients can receive 28 days of take-home doses of medication. States can also request up to 14 days of take-home medication for less stable patients, but only if their OTP believes they can safely handle that level of take-home medication. Existing patients can continue working with their practitioner via telehealth, but new patients will be required to complete a physical evaluation. For unstable patients, such as someone who is still abusing opioids, they will be required to continue traveling to a facility each day to receive their medication. Many states have released the same safety guidelines for their OTPs, including:
These guidelines include the Interim Infection Prevention and Control Recommendations released by the Centers for Disease Control and Prevention (CDC) that offer advice on protecting healthcare personnel, limiting the spread of germs in facilities, and isolating symptomatic patients. For patients who arrive at OTPs with a fever or cough, they can be separated from the lobby and general dispensary to receive their dose in a closed room. Patients with confirmed COVID-19 disease and patients with a respiratory viral illness may be prescribed take-home medication for up to 2 weeks. At-risk patients, such as those over age 60, those with pulmonary, cardiac, renal or liver disease, or immunosuppression are eligible for take-home medication for up to 7 to 14 days. This is left to the discretion of the medical prescriber.
Some people are feeling fear or anxiety about traveling to a facility to receive their treatment medication. For many, there is no other option. Over 67,000 Americans died in 2018 from an opioid overdose. Returning to the use of illicit drugs like heroin and fentanyl is extremely dangerous and can easily lead to an unintentional overdose. Continuing treatment medications and counseling is a life-saving measure for many Americans. It is important to adhere to the guidelines put in place by SAMHSA and the CDC but remain in your treatment program. Individual’s OTPs can be contacted for information on what is the safest option to continue receiving treatment medications during COVID-19.
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