For the 30,000 patients who take methadone every day for opioid use disorder in New York City, one big worry was potentially taken away this week. If they are not able to get to their opioid treatment program (OTPs, commonly known as methadone clinics) because they are quarantining with COVID-19 or symptoms of it, they can now get their medication delivered to them via a courier.

New York state’s Office of Addiction Services and Supports (OASAS)—in conjunction with the New York City Department of Health-Mental Health (DOHMH), the NYC Department of Homeless Services (DHS), and the private Coalition of Medication-Assisted Treatment Providers and Advocates (COMPA) of New York—has rolled out the “NYC OTP Methadone Delivery System.”

This started on April 20, with methadone delivered to New Yorkers in DHS Isolation Hotels, OASAS spokesman Evan Frost told Filter.

Deliveries will be conducted by a combination of OTP staff and drivers employed by the NYC health department.

Filter was first informed of this development by Allegra Schorr, president of COMPA, who said the move was spurred by Filter’s report on the problem, published on March 26. Schorr was quoted in that report as noting that the federal government would allow “doorstep delivery,” but only if it were done by OTP staff. She said that OTPs didn’t have the capacity to do this, and that “We’re going to need some outside agency like the National Guard.”

Rather than the National Guard, deliveries will instead be conducted by a combination of OTP staff and drivers who are employed by the NYC health department, managed by state and city health authorities and the OTPs themselves.

The system will be rolled out in two phases: The first, which has already begun, is getting methadone delivered to patients who are in the hotels set up for homeless people who need to be isolated. The second, due to start before the end of this week, will consist of deliveries to private residences.

This will be done via the protocol of “guest-dosing,” combined with a “designated other” who will serve as the courier. Here’s how the first phase of deliveries works.

The patient is assigned to a hotel—a real hotel, now converted to an Isolation Hotel reserved specifically for homeless people who are, or might be, COVID-positive. There are currently five such hotels in the city. The patient’s “home” OTP may be far from the hotel. So the patient authorizes a “designated other”—a courier, who is an employee of the city’s Department of Health—to pick up their methadone from a “guest” OTP.

After the patient signs an authorization and consent, the medication will be routed through from the home OTP to the guest OTP. The authorized courier will then bring the methadone from there to the patient’s hotel, and deliver it to a nurse—all of the Isolation Hotels have nurses. The courier and the nurse will witness the transfer in a chain-of-custody document.

The courier will bring one week’s worth of doses at a time, which will then be placed in the patient’s lockbox—all patients will be provided with a lockbox in which to keep their methadone. (Schorr said she was impressed by the quality of the lockboxes purchased by the city.)

Nobody will stay in the hotels more than 14 days, as that is the length of time stipulated for quarantine or isolation. Patients will then either leave the hotels to return to shelters, or, if they need to, go to the hospital.

There are currently about 30 homeless patients—either living on the streets or in shelters—entering the city’s OTP system every week, said Schorr. There are a total of 64 OTPs in New York City serving 30,000 patients. Of these, eight are authorized to provide guest dosing.

Home deliveries will start next, operating along similar lines but obviously required to deliver methadone to a much larger number of locations. Patients in private residences who are unable to obtain their medication due to quarantine or isolation, or who are experiencing symptoms of COVID-19 will be eligible, Frost told Filter.

Schorr, who is also owner and vice president of West Midtown Medical Group, a Manhattan-based treatment program that dispenses methadone and buprenorphine, said she is on calls more than once a day with the city working on this new system.

“This is brand new, basically in response to your article,” she said. “We’re looking at something far beyond our capacity, with the pandemic hot spot and the numbers of patients [in isolation] that we have.”

The federal government had already temporarily revised its guidelines, allowing all patients deemed stable to get 28 days of take-home methadone doses, and “less than stable” patients to get 14 days. However, it’s up to the OTP to decide who is placed in these categories.

The courier system, which involved coordination between City Hall and several city and state agencies already dealing with a huge health crisis, is a welcome way to help methadone patients navigate current circumstances. The overdose crisis continues regardless, making it vital that isolated patients get their daily medication rather than going into the street in search of something else to stave off withdrawal.

Photograph of an MTA van in Brooklyn by Adam E. Moreira via Wikimedia Commons/Creative Commons 3.0.