On April 29, New York City started delivering methadone to patients isolated at home due to the coronavirus. The courier system was rolled out last week, as Filter reported, with deliveries to patients in Isolation Hotels. The aim is to reduce both the spread of the virus and the prospect of methadone patients unable to pick up doses seeking risky alternatives.
Filter talked to Denise Paone, EdD—director of research and surveillance for the Bureau of Alcohol and Drug Use Prevention, Care and Treatment at the New York City Department of Health and Mental Hygiene—the day the home deliveries began. She estimates that over a two-month period, about 1,000 individual patients will receive home deliveries, for a total of 1,300 deliveries—although this number may rise if necessary.
There are 30,000-plus methadone patients in New York City. Patients’ opioid treatment programs (OTPs, often known as methadone clinics) determine who is eligible, based on criteria set up by the city and the OTPs together. Only those deemed able to receive two weeks of take-home doses safely will get deliveries—the rest will still have to attend their OTP.
For eligible patients, the OTP must make the referral to the city by 3 pm on the day before the delivery is to be made. “The OTP tells us that this individual person needs their methadone tomorrow,” said Paone. “There are a lot of details to set up.”
She said that the system—involving couriers employed by the city, chain-of-custody documents and “guest dosing” protocol for patients whose “home” OTP is not their nearest—is basically the same as the one used for deliveries to Isolation Hotels. But the methadone is delivered directly to the patient, at curbside outside of their residence, instead of to a nurse, as at the Isolation Hotels. All of the delivered methadone doses are in liquid form.
“The person will know we’re coming because we’ll call first,” said Paone. “They’ll come downstairs with a face mask on. We put the lock box down, and we confirm their identity.” The lock box with the methadone inside is in a bag so it is not obvious, she said.
Last week there were six teams of health department employees delivering methadone to patients in Isolation Hotels across four boroughs (OTPs can handle Staten Island deliveries on their own, said Paone). By next week, as deliveries to private homes increase, there will be 10 teams.
Although it’s unlikely that the city will be continuing home deliveries forever, the program may encourage some longer-term changes in the methadone rules.
“We have a very comprehensive chain of custody” for the methadone, said Paone. The medication gets signed out from the clinic to the courier. “At the end of the day, OASAS [the state agency with jurisdiction over OTPs] has a full accounting.”
She further commented on why many New York City methadone patients are not eligible. “Right now the protocol is that the person has to be on 14 days [of take-home doses] or more” to get the deliveries,” she said.
Paone did, however, note that the OTPs “really have bumped people up” to getting more take-homes in these circumstances. Patients who still have to go into their OTP have been told by the city and state about social distancing protocol and requirements for staggered visiting times.
Although it’s unlikely that the city will be continuing home deliveries forever, the program may encourage some longer-term changes in the methadone rules.
“I think we would be in favor of seeing some changes to the regulations in general post-COVID,” said Paone. “The best way to do that is through the data, and we’re thinking about what kind of study we can do. We don’t have it worked out yet, but this is a critical moment.”
So far there has been no negative feedback from the DEA or the police, she added. “We have not had any pushback. And we really recognize the importance of doing this right now. It was slower than people wanted.”
Experts have praised the move. “You have to commend New York for exploring an innovative way to meet the needs of patients in that jurisdiction who are on medication-assisted opioid use disorder treatment, especially during the current pandemic,” said H. Westley Clark, MD, JD, former director of SAMHSA’s Center for Substance Abuse Treatment. He emphasized that the model should be evaluated “for administrative issues that might surface,” but added that “the willingness of all, including the patients and programs, to explore a new avenue for treatment access is clearly important.”
The effort, Clark told Filter, “sets the stage for exploring alternatives to the existing model of care, fostering better patient centered service delivery.”
“External events like the COVID-19 pandemic provide us with the need and necessity to explore options and modifications of the existing system of care,” he continued. “I also think that this represents an effort to treat people with OUDs with dignity and respect by tailoring strategies that meet their unique needs. My hope is that such efforts will not cease as the pandemic wanes. I also realize that others call for more sweeping change and that those calls may have merit, but while those calls are being addressed, the current project of courier deliveries is a step in the right direction.”
Meanwhile Rob Kent, until last month longtime general counsel for OASAS, told Filter: “It is a victory for patients who need methadone to support their recovery. It is a great and necessary patient-centered step in the middle of this pandemic and one I hope survives the pandemic and becomes a permanent practice. It is also a good step in support of mobile methadone which hopefully becomes a reality soon! The important thing is to track the data to show the real impact of this and other flexibility offered (extended take homes, telephonic bupe initiation) to show it worked without harm to patients and should be continued.”
Here are the eligibility criteria for the NYC methadone home delivery program, as provided by the New York City health department:
∙ Individuals diagnosed with COVID-19 or have symptoms of COVID-19
OR
Individuals referred by the Medical Director of the Opioid Treatment Program (OTP), with the following criteria as guidance:
Aged 65+ AND OTP willing to provide a minimum of 14 days of medication AND have any of the following health conditions*:
o Lung disease
o Moderate to severe asthma
o Heart disease
o A weakened immune system
o Obesity
o Diabetes
o Kidney disease
o Liver disease
o Cancer
*Depending on the capacity, the Health Department may revise the guidance in the future
Photo via PxFuel/Public Domain
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