There are about 30,000 methadone patients in New York City, all taking methadone on a daily basis for opioid use disorder. About 15,000 of them are going to be isolated because of suspected exposure to or contracting of coronavirus, according to a New York City Department of Health estimate given to the top private-sector opioid treatment program official in the state. Allegra Schorr—president of the Coalition of Medication-Assisted Treatment Providers and Advocates (COMPA) of New York, and owner and vice president of West Midtown Medical Group, a Manhattan-based practice that dispenses methadone and buprenorphine—told Filter that she is in constant contact with the city’s health department about this problem.

The department’s modeling is renowned, and while the figure remains unofficial, it tallies with the mayor’s prediction that half of all New Yorkers will eventually contract the virus.

So how will those 15,000 patients who won’t be able to go to the clinic get their methadone? And what will they do if they can’t?

Amid the crisis, the Substance Abuse and Mental Health Services Administration (SAMHSA) has issued revised temporary guidelines allowing opioid treatment programs (OTPs) to give stable patients 14 or 28 days of take-home doses—putting the onus on OTPs to decide who is “stable.”

OTPs can also be held liable if anything goes wrong; federal agencies are by definition indemnified. So SAMHSA’s move—while welcome—in a sense just passes the buck while that legal situation remains. It’s causing OTPs great concern given SAMHSA’s eight-point criteria and the potential of methadone, like any opioid, to be involved in fatal overdose, either of the patient or of another person to whom it’s sold or given. Schorr’s facility is trying to strike a balance between giving more take-homes, but not a universal 14 or 28 days. For example, patients who have been coming in daily will be given take-homes on a staggered schedule, every two or three days. This is what most OTPs across the country are currently doing.

Patients’ getting take-homes can help. But even if they are all permitted to receive them—which they will not be—that does not help people who cannot go to clinics due to isolation for coronavirus.

SAMHSA has instituted provision for “doorstep delivery” of methadone to isolated patients, but is asking OTP staff to do this. This will not be possible for the numbers of patients projected to need this service.

“The system is not set up for delivering methadone to 15,000 patients,” said Schorr. “We’re going to need some outside agency like the National Guard.”

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