“You can’t put the genie back in the bottle,” said Stephen Loyd, a Tennessee addiction doctor who once served as the state’s drug czar. “This is how it needs to be — always.”
Thousands of Americans who have long begun every single day with a taxing trip to an addiction clinic for a single dose of methadone, another highly regulated addiction drug, are now receiving 28-day take-home supplies, rendering the in-person visit and potential coronavirus exposure unnecessary. In New York City, some clinics have even delivered methadone supplies by courier — a 180-degree shift away from the federal government’s longstanding and heavy-handed regulation of methadone, an opioid that’s used to treat both addiction and pain.
Loyd, the former Tennessee drug czar, said telehealth visits have allowed him to gain insight into his patients’ living situations, which has often led to critical discoveries about their life circumstances that he would otherwise have missed.
“I found three patients in the past two weeks that I didn’t know were homeless or living in a car,” Loyd said. “So we’ve been able to hook them up with some housing services that we have access to.”
Other advocates, while welcoming many of the temporary changes, have expressed only cautious optimism, particularly regarding methadone, a drug that, when misused, can easily lead to overdose. Others fretted the changes to privacy laws could leave addiction patients vulnerable to stigma and discrimination. And, many stressed, while expanding treatment for opioid addiction is likely to help thousands of Americans, it does little for others addicted to other drugs including methamphetamine, cocaine, and alcohol.
Mark Parrino, the president of the American Association for the Treatment of Opioid Dependence, a group that largely represents methadone providers, recalled that one of his board members had recently mused that there had never been more of the drug in patients’ hands.
“We have to hope that most of it is being used as dispensed, and not being sold on the black market or being misused by the patient,” he said, adding that he had heard a small number of anecdotal reports that some patients had overdosed on take-home medications.
Parrino stressed that those reports were only anecdotal — but that he also expects federal regulators, including the Substance Abuse and Mental Health Services Administration, to return to a more typical regulatory structure in the future.
A SAMHSA spokesman said in a statement that the agency “would continue to monitor those flexibilities and how they are working,” noting that many would require action from Congress to remain in effect.