At the June 21 Coalition of Medication-Assisted Treatment Providers and Advocates (COMPA) symposium, opoid treatment providers (OTPs) from across New York learned how the state is facilitating easier access to methadone, much of which is due to flexibilities which originated in the COVID-19 pandemic. These flexibilities include more take-home medications, which Chinazo Cunningham, M.D., the state’s Commissioner of the Office of Addiction Services and Supports (OASAS), strongly endorses. This topic came up at last year’s COMPA symposium as well (see https://atforum.com/2022/07/methadone-reform-in-ny-part-1/, https://atforum.com/2022/07/methadone-reform-ny-part-2/).
This year’s symposium was subtitled “Care Transformation in a Post-Pandemic World,” and also focused on methadone treatment in jails and prisons. New York is the only state in the country to have mandated that all three medications to treat opioid use disorder be available in prisons and jails; for OTPs, this has been a key new market, because so many inmates overdose and die when they are released.
In addition, the problems of fentanyl were stressed. Because this drug is so potent, buprenorphine is often not adequate, treatment providers said. Methadone has a higher morphine equivalency, and can “hold” patients addicted to fentanyl much better than buprenoprhine can.
In terms of take-homes, like last year, OTPs are worried about being able to strike a balance between giving as many take-homes as are safe for the convenience of the patient, and not giving too many because of public safety (and the safety of the patient and his or her family).
Under COVIDUnder COVID-19 guidelines, in order to prevent patients from going to the OTP to get their methadone and therefore be exposed to, or more likely to transmit, the virus, take-homes for the first time in the country were allowed for patients who were unstable. While the federal guidelines allow for 28 days of take-homes, this is only for stable patients. This more liberal policy of take-homes is espoused by OASAS, and Dr. Cunningham at the COMPA meeting stressed that there have been no methadone overdose deaths according to a federally sponsored study as a result of the take-home flexibilities.
However, it’s important to remember that just because there haven’t been overdose deaths due to methadone, that doesn’t mean there haven’t been overdoses, Mark Parrino, president of the American Association for the Treatment of Opioid Dependence (AATOD) told symposium participants. At last year’s symposium, OTPs relayed that when drug testing started up again in clinics, many new patients came in with methadone in their system. Where were they getting it from? As Parrino also stressed, the liability is solely with the OTP if there is an adverse event from the OTP’s dispensed take-homes.
During a later session, OASAS staff noted that indeed, insurance premiums can go up for OTPs because of the increased flexibility. This doesn’t mean that take-homes should not be given, but it is “something to keep in mind.”
Dr. Cunningham’s only criticism of the group, however, was that take-homes are going down, not up.
Also going down, not up: patients in treatment in OTPs. This can’t be a good thing, with so many opioid overdose deaths still taking place. And even though the federal government insists it is increasing access to treatment, when Parrino asks what they mean by treatment, they say “medication,” which does not treat the multiple problems patients present with.
More news: New York’s beloved Belinda Greenfield, the former State Opioid Treatment Authority, is now with the Division of Pharmacologic Therapies at the Substance Abuse and Mental Health Services Administration (SAMHSA), which she represented at the symposium. So you have a friend in Washington.
Stay tuned for more on New York’s OTP system.