Medication-Assisted Treatment (MAT) during the Coronavirus Pandemic

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Shlomo Hoffman
Mar 23, 2020

Suboxone

Suboxone and Methadone are two widely used medications to relieve opioid addiction. Many consider Suboxone a safer option than Methadone. It’s a combination drug, made up of buprenorphine and naloxone. The buprenorphine element blocks withdrawal symptoms when someone stops using other opioids. Naloxone has the opposite effect. It stops the opioid high. Suboxone combines the two.  This controls withdrawal symptoms while slowly lowering the body’s craving for pure opiates. It has a lesser risk of misuse and addiction than methadone.

While it helps manage cravings, someone suffering from Opioid Use Disorder (OUD) needs to enter addiction treatment to achieve full abstinence. Suboxone should only be used as a recovery maintenance tool. It is used together with the therapy needed to get well and is therefore known as Medication-Assisted Treatment (MAT).

Methadone

Methadone works differently. It is in essence a substitute for more harmful opioids like heroin. Although it activates the opioid receptors in the brain, it does so at a slower pace and does not cause the same euphoria as other drugs in opioid dependent persons. It does however carry a higher risk of abuse and addiction. It is the subject of controversy in the opioid addiction field and should be approached cautiously. Like Suboxone, it is a maintenance medication and should never be used without accompanied treatment like those offered in addiction treatment facilities. This includes therapy sessions, and other evidence-based models.

Challenges of MAT during the Covid-19 outbreak

The Covid-19 pandemic has presented challenges to people suffering from addiction in getting the doses they need. Although unlike Methadone, it can be prescribed out of a licensed office as opposed to a special clinic, there are generally restrictions in place. In normal times, Suboxone cannot be prescribed without an initial physical evaluation at the treatment center. With stay at home orders in place in many states, this has become very difficult.

Opioid Treatment Programs (OTPs) must deal with increased health protocols, many staff is stuck at home, and admissions appointments are difficult to schedule. Additionally, the dosages a patient may take home at one time is usually limited. These regulations were made to control the risk of misuse. A new reality has now made it difficult to constantly go out and refill prescriptions.

It is very important not to forget the opioid addiction community in these trying times. The risks of relapse when people are forced to be alone is significant. People are stressed and scared. Confusion and uncertainty are swirling. It is a time of danger for the recovery community. We need to make sure they have all the tools necessary to combat temptation. It is a matter of life and death.

Telehealth Prescriptions

Suboxone

Thankfully, the federal government has taken measures to ease the burden of Suboxone patients. Being that the Controlled Substances Act has exemptions for public health emergencies, new guidelines have taken effect.  OTPs can now prescribe the medication after a Telehealth evaluation. The requirement to undergo a physical exam has been waived. Virtual appointments can be set up and a patient can get started on a Suboxone regimen right away. If you have a loved one in your life who can benefit from such treatment, do some research. Find an OTP or doctor that can help someone begin treatment from the safety of his home.

Methadone

The guidelines for methadone prescriptions are a bit different. Due to its higher risk of addiction, a full physical evaluation is still required. Prescription are only available from specialized Methadone clinics and can’t be prescribed at a regular treatment office.

Once a person suffering from OUD has started a regimen, restrictions on continuing prescriptions without physically coming to get them has been eased. Once again, research the evolving guidelines and ask for guidance from your doctor.

Ask your addiction treatment provider for guidance!

It is important to note that detox in many cases needs to be done under medical observation and care. Ask a medical professional for guidance on how to best proceed. Follow their advice for the best way to help a loved one in need.

Linked here is a DEA resource page regarding Telehealth procedures and prescriptions.

https://www.deadiversion.usdoj.gov/coronavirus.html

Opioid Medication Delivery

Delivery of necessary medication has become difficult as well. Patients under quarantine orders cannot leave their homes. Others are under statewide stay-at-home orders. Many are simply scared to leave. If you know someone is such a situation stay in touch! Make sure they know how to get their meds. More importantly, show them they are not alone. A feeling of connection to others will help them greatly.

Linked here is information regarding safe medication delivery protocols from the government site samhsa.gov. Besides this info, the site is offering a wealth of guidance for controlling addiction during the coronavirus outbreak. Check it out and pass it along!

https://www.samhsa.gov/sites/default/files/otp-covid-implementation-guidance.pdf

Dosage limitations

The federal government has eased restrictions on take home limitations. An OTP can now prescribe a stable patient up to 28 days’ worth of refills. Even in cases of less stable patients 14-day refills are possible, per the discretion of the state and with the guidance of the clinic treating them.  

Here is some info regarding the new refill guidelines.

https://www.samhsa.gov/sites/default/files/faqs-for-oud-prescribing-and-dispensing.pdf

Helping loved ones maintain their recovery.

The importance of a support system for members of the recovery community cannot be overstated. Make sure your loved ones know their options. Be certain someone is checking on them. Encourage them to take advantage of virtual 12-step meetings. If they are enrolled in outpatient addiction treatment, find out what their provider is doing to continue treatment. Many facilities are doing everything they can to keep their doors open. There are therapists scheduling online sessions in safe HIPPA compliant atmospheres such as Doxy.me. Keep in touch with your counselor and take advantage of what they are still able to offer.

Let’s stay together!

We cannot forget about the opioid epidemic even in the shadows of the coronavirus pandemic. Lives are at stake and we can all do our bit to ensure those less fortunate are not lost in the shuffle. The recovery community is banding together to save lives.

Let’s join hands and come together with those on the front lines!

Since joining the Avenues Recovery content team, Shlomo has become a thought leader in the addiction field. His popular addiction podcast "Rubber Bands" is a must listen for anyone involved in Substance abuse treatment. He is a Seinfeld junkie, a recovering Twitter fanatic, and a sports expert. He enjoys milk shakes and beautiful views from rooftops.

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