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Under SAMHSA’s guidance, those states that have declared a state of emergency may make a blanket request to allow all opioid treatment programs (OTPs) to provide stable patients with four weeks of medication to take home. 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.
OTPs operating in states that have not declared a state of emergency may also take advantage of the same guidance by requesting a blanket exemption request for its clinic.
SAMHSA stipulates that programs and states should use “appropriate clinical judgment and existing procedures to identify stable patients.” The administration also notes that the requests to take advantage of the new guidance do not need to be made on a per-patient basis.
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 member of APA’s Council on Addiction Psychiatry. When patients initially start OUD treatment with such medications, they must make daily trips to their OTP to get their dose.
“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 told Psychiatric News in an email. “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) on Monday also announced in a letter that it has eased restrictions of who can dispense medications in cases when a patient is 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 the patient’s home. The change applies only while 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.”
For related information, see the Psychiatric News article “Stigma, Misunderstanding Among the Barriers to MAT Treatment.”
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