When New York State closed all essential businesses in late March, it left millions of people with questions about how to get medication without putting themselves at risk for COVID 19. That includes the nearly 30,000 people who receive methadone to treat opioid addiction across New York City, 15,000 of whom will have to isolate at home at some point during the pandemic, according to the city’s Department of Health.
On April 20, New York City introduced a pilot program to deliver methadone to some patients isolating due to COVID-19. While the amount of deliveries so far is small — only 20 deliveries were made to a total of 17 people as of May 5 — it’s a huge step that advocates are hoping could be a model for how NYC, and cities across the country, provide opioid treatment even after the pandemic subsides.
“It’s amazing, unprecedented, ground-breaking and will be something that we’ll continue to fight to make sure that it stays in place after COVID has passed,” says Jasmine Budnella, drug policy coordinator at the non-profit VOCAL NY, a statewide organization that addresses homelessness, HIV/AIDS and the drug war..
Deliveries began in the last week of April to people isolated in hotels, starting with people experiencing homelessness and expanding to those isolated by the state’s Office of Emergency Management because of their symptoms. A representative from the Department of Health said the city is hoping to begin methadone deliveries to homeless shelters by next week.
The city’s Department of Health told Next City that as of May 7, people who were recently released from city jails due to COVID-19 vulnerabilities would receive methadone at hotels where they are being isolated by the Mayor’s Office of Criminal Justice.
And beginning the same week, deliveries are being made to some private residences, beginning with people who are COVID-19 positive or who have symptoms, and elderly, high-risk populations.
The path was paved when federal regulations were eased early in the crisis. On March 16, the federal government lifted limits for take-home doses of opioid treatment. Normally, methadone is tightly regulated, with take-home doses limited. States could request a waiver that would allow for up to 28 days of take-home doses for patients considered “stable,” and 14 days of doses for those who are less stable. If a state’s waiver is approved, changes apply to everyone in the state, although a patient’s individual physician must decide the correct dose and take-home supply. On the same day, the federal Drug Enforcement Administration temporarily permitted delivery of methadone, which is used to treat opioid addiction because it limits withdrawal symptoms and reduces cravings.
Budnella said that providers were hearing from advocates, from people with addictions, and their loved ones, who were initially alarmed by the state’s stay-at-home orders and were not getting clear information about how to get opioid treatment while isolating. As people in the community pushed providers to make deliveries, they realized many wouldn’t have the capacity.
Allegra Schorr is president of the Coalition of Medication Assistant Treatment Providers, and owner of West Midtown Medical Group, an opioid treatment provider. Schorr says once she realized methadone would have to be delivered, it was clear her organization wasn’t prepared to do it. Her staff lacked personal protective equipment, and many were starting to call in sick.
Schorr says she reached out to state agencies, including the Governor’s office and the state Office of Addiction Support and Services, as well as the state and city departments of health. The agencies came together to help launch a methadone delivery program, led by the city’s Department of Health and the NYC Mayor’s Office.
Dr. Denise Paone, director of research in the city’s Alcohol and Drug Use Prevention Bureau, says the program, while small right now, will expand in the coming weeks.
It currently consists of six “teams,” consisting of a driver and a courier who deliver methadone in lockboxes, each delivered with a key to the patient. Because it is possible to overdose on methadone, lockboxes will come with naloxone, a drug used to reverse overdoses, as an additional precaution. To save time, the program will use “guest doses,” filled by clinics other than the client’s regular provider.
Dr. Paone says the Department of Health is adding four more teams this week, but did not want to provide an estimate for how many people would be receiving deliveries.
She says that one of the reasons the program hasn’t reached more people is because the Department of Health hasn’t received as many referrals as they initially thought they would. Even if a patient is receiving methadone, home deliveries have to be approved by a physician at their local treatment center. Patients receive guidance on their doses over the phone.
While advocates have praised the city’s approach, the availability of opioid treatment has been uneven across the state. Many providers upstate have not taken advantage of the federal government’s more flexible take-home requirements, says Budnella. While some people are getting 10, 14, or 28 days worth of methadone or other opioid treatments, some folks are still coming in every other day for their dose, putting themselves and others at risk.
Grace, 27, lives in Broome County, in the southern tier of New York State, where she receives Suboxone, an opioid treatment drug, from a local clinic. Her provider – United Health Services — is the only opioid treatment provider serving 11 neighboring counties. She says the clinic rarely gives people any take-home doses, requiring people to receive their doses on-site. Grace, who has been clean for four years, says there are long lines with little attempt at social distancing at the clinic.
“When it first started, they didn’t take it [COVID-19] seriously,” she says of the provider. She said inside the clinic, social distancing was being maintained. But staff made clients stand in the hallway, where there was a long line of people standing close to each other.
“When I got in there, I was like what is the point of putting us in the hallway if you’re going to have us stand right next to each other?,” she says.
Alexis Pleus, executive director of the non-profit Truth Pharm, a Broome County-based advocacy group for people with addictions, estimated that only 10 percent of people who need opioid treatment in the county have been getting take-home doses, based on her conversations with people who have addictions.
Pleus says that a program like NYC’s would be transformative. “It’s incredible and it’s a perfect example of how we should be servicing our vulnerable populations right now,” she says. “It’s so heart-breaking because it could really help folks here, especially when they don’t have means of transportation to get them around. It just doesn’t get implemented here.”
Budnella, of VOCAL NY, is grateful that the program exists, but wishes there had been more coordination across the state to mitigate holes in coverage, like those in Broome County. She says funding and lack of coordinated interest has created inequities.
“Harm reduction has not been funded well. If we had a strong infrastructure the pandemic wouldn’t have created these glaring holes,” she says.
NYC’s program is not without its drawbacks. Budnella says most of the hotels in which people are being isolated don’t have nurses or staff on-hand to deal with potential overdoses or to check in periodically on the well-being of people with addictions, increasing the chances of overdose. Despite the risks, the delivery model is one that VOCAL-NY hopes to keep in place.
City officials say it’s possible the delivery program could persist in some form after the pandemic has passed. Dr. Paone says the city will look at the data to determine what shape a delivery program might take. “I think the hope is that you could move to a different model,” she says.