When the pandemic hit full force in mid-March, the State Opioid Treatment Authorities (SOTAs) had to move fast. They regulate opioid treatment programs (OTPs) in their respective states, and well knew that many patients had to visit the clinic frequently. “Social distancing” was possible, but “virtual” treatment was not. To get medication, the patients had to be there.
Smith Worth, LCSW, SOTA of North Carolina, talked with AT Forum about what she has been doing.
Calls with OTPs. “We’re meeting weekly with OTP program directors, and then having a separate call with medical directors and prescribers,” she said. Regular calls—on a monthly or quarterly basis—had been the norm with medical director for many years already, she said.
Overcrowding. Almost immediately, overcrowding was an issue in some clinics, but Ms. Worth was able to get those issues fixed quickly, coming up with a “correction plan.” Under normal circumstances, it would not have been a problem, but there was no opportunity for six-foot distancing in these centers. The plan was for patients to park in the lot and notify the clinic, which would then let them know when it was time to come in for medication, said Ms. Worth.
14- or 28-day take-home doses. Under the Substance Abuse and Mental Health Administration (SAMHSA) rules allowing 14- or 28-day take-home doses for patients who are stable and those who are less than stable (see https://atforum.com/2020/03/otp-regulations-loosened-due-to-pandemic), clinics would need to make sure patient times are staggered, so that large numbers of patients are not coming at the same time.
Disasters. North Carolina has some experience with the needs of OTPs during disasters. “We have learned a lot through the past four years of hurricanes and flooding, but nothing could have prepared us for what we have right now,” said Ms. Worth. The state’s 76 programs—serving almost 20,000 patients—have eased some of the anxiety surrounding the pandemic, she added.
Getting Prepared: The Timeline
In North Carolina, officials first talked about the pandemic in the middle of February. “This was before we got guidance from SAMHSA or the Drug Enforcement Administration,” Ms. Worth noted. “But we had a disaster plan already for OTPs.” This included making sure that they had increased medications on hand, and had developed relationships with temporary agencies in case they needed replacement staffing.”
Part of the preparation including making sure that the 14-day and 28-day take-home doses were reimbursed. “Our experience with the hurricanes was that programs lost a lot of money, because if they gave blanket take-homes for their patients for a week, they only got reimbursed for that one day, and then they lost the reimbursement for the take-homes that the patient couldn’t pay for.”
However, the reports about telecounseling have been very positive, said Ms. Worth. Patients are communicating more frequently with their counselors. Additionally, some clinics have seen attendance double for tele-group. “Patients and staff have responded tremendously” to telehealth. “This is going to be a challenge for all of the states going forward,” she said. “We have this unplanned experiment, and it went extremely well. What are we going to do with it?”
On the other hand, there were some patients, especially new patients, who wanted to go to the clinic every day. “We have encouraged programs to have staff available, for these patients,” said Ms. Worth. “None of our programs are closed.”
Another important aspect of the change has been the leadership role of the medical director. More than ever, the medical director must attend to all aspects of OTP function and to communicate directly with the SOTA as events warrant such as in the case of a patient overdose.
All the OTPs are balancing the risks of harm reduction (more take-home doses) with the risks of diversion or overdose. “We want to keep patients safe from the virus, but we also have to keep a close eye out for on overdoses and relapses.”