Imagine having to wake up every day at 5 a.m. just to travel to a clinic miles way for a single dose of your high-blood pressure or heart disease medication.
That’s the kind of contortion that most patients on methadone, a synthetic opiate drug prescribed to treat opioid addiction, have been required to do for decades, because of overly onerous federal regulations. It has taken nothing less than a global pandemic for the government to finally loosen the rules so that methadone patients spend less of their time traveling to clinics.
Since the outbreak began, federal and state authorities have begun allowing patients to get 28-day take-home doses because most treatment centers are operating under reduced hours and limited face-time with patients. Buprenorphine, another drug that only a limited number of doctors are allowed to prescribe, is also easier to access during this time: patients are now able to use telemedicine, via video-chat or telephone, to “see” their doctors and get a prescription.
Before the coronavirus pandemic hit, there was the opioid overdose epidemic to contend with — which has now become a crisis within a crisis. But in a remarkable case of coronavirus silver linings, medications to treat opioid use disorder have never been easier to access, and there are even signs that more patients are seeking treatment.
Arguably the biggest reform was a federal waiver, issued in mid-March by the federal agencies in charge of regulating methadone, that allowed the 28-day doses. Before COVID-19, only about 16 percent of patients in methadone programs in Massachusetts were eligible for 28-day doses — they had to meet eight strict criteria, such as demonstrating they’re not abusing any other illicit drugs or alcohol, and that they have access to stable housing. Now, between 60 to 70 percent of methadone patients in Massachusetts, which total about 23,000, have received take-home doses over the past month or so, according to state officials.
Reducing the time for these patients to go to the clinic is desirable because that keeps them in treatment. Plus, requiring patients to show up at treatment centers daily makes them more vulnerable to relapse; there is often a concentration of illegal drug sellers around and outside methadone clinics.
Pre-pandemic, the risks cited to justify tight methadone controls have been diversion to the black market and overdose. But public health advocates and officials have argued those risks are minimal. “For the most part people are motivated to stay in good standing in their treatment,” said Devin Larkin, director of Boston’s Bureau of Recovery Services. The latest available data bears that argument. As of last week, the state reported it had received 19 instances of possible diversion among the thousands of take-home patients across the entire state, and no overdoses so far.
Other places are experimenting with the sudden relaxation of rules. New York City launched a small but first-of-its-kind program last month that offers door-to-door methadone delivery to homeless shelter residents and patients placed in isolation hotels. Earlier in May, the city started delivering methadone to vulnerable patients in private homes, as well.
Massachusetts is also doing what it can. For instance, the state is reimbursing treatment centers for lockable containers to give to methadone patients so they have a place to keep their doses safe while staying at a homeless shelter or an isolation recovery center for COVID-19 patients.
Meanwhile, it’s too soon to say whether the opioid crisis is worsening or not during the pandemic. But there is some anecdotal data that seems promising. Dr. Alexander Walley, a general internist and addiction specialist at Boston Medical Center’s Grayken Center for Addiction, has noticed a small increase in people seeking treatment during the pandemic.
“We were not expecting that,” he said. “People are worried that they’re not going to have access to their drug of choice, whether that’s fentanyl or heroin. They don’t want to be stuck in withdrawal so they’re seeking treatment.” Another reason, he added, might be economic. “The slowdown certainly affects people using. Even if fentanyl and heroin are available for sale, they don’t have the money to buy it and that gives them an incentive to enter treatment.”
Walley has long advocated for making addiction treatment more patient-centric. “I’m hopeful that we will take advantage of the innovations during COVID-19 so that we can make the treatment work for the patients, and not make the patients work hard for their treatment,“ Walley said.
The coronavirus has made possible these groundbreaking reforms, which represent the most substantive changes in addiction treatment in more than 40 years. The country is conducting a live experiment of what happens when patients are allowed to take methadone home or to check in online with their doctor to get their doses of Suboxone. And guess what? The sky isn’t falling.
This current “pilot program” should pave the way to end a legacy of stigma around methadone and other drugs prescribed to treat addiction. They should be treated as any other form of medication that can be prescribed as part of primary care and through pharmacies. It’s about time.
Editorials represent the views of the Boston Globe Editorial Board. Follow us on Twitter at @GlobeOpinion.