Editor-in-Chief of CATR. Clinical Instructor in Medicine and Pediatrics at Yale School of Medicine; Chief Medical Officer at Fair Haven Community Health Care, CT.
Dr. Oldfield has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has changed some prescribing rules to help minimize in-person contact while maintaining access to medications for opioid use disorder (OUD).
Methadone Patients starting methadone continue to require an in-person medical evaluation at an opioid treatment program (OTP) prior to starting the medication. However, patients already on methadone can receive their ongoing care via telemedicine visits. Furthermore, OTPs can now more easily provide take-home doses. Take-home doses are now allowed for up to 14 days for “clinically less stable” patients and 28 days for “clinically stable” patients. The definition of stability is left to the OTP. For example, SAMHSA characterizes those eligible for 14 days as “less stable but whom the OTP believes can safely handle this level of take-home medication.”
Buprenorphine Patients no longer need in-person visits prior to starting buprenorphine. If you determine that an adequate evaluation of the patient can be accomplished via telemedicine, this is sufficient. Ongoing care can also occur via telemedicine.
Monitoring Current federal regulations still require that each patient receives 8 urine toxicology tests per year. However, new guidelines acknowledge that we should not require patients to come into the clinic for testing if they have symptoms of COVID-19 or if they have had close contact with someone who has the infection.
CATR Verdict: The government is taking appropriate measures to allow and expand treatment for OUD while reducing the spread of COVID-19. Addiction providers should explore telemedicine options that support patients with OUD given recent increases in social isolation, job loss, and anxiety, all of which may worsen the burden of OUD. Because your patients may have larger than normal doses of methadone or buprenorphine at home, you should discuss safe storage practices, provide overdose education, and distribute naloxone.