As coronavirus (COVID-19) cases increase exponentially and containment measures expand across the country, another public health emergency – the opioid use disorder (OUD) crisis – continues to rage. For individuals in treatment for OUD and those who provide them, COVID-19 presents a new set of barriers that make accessing these critical services challenging.
Office-Based Outpatient Treatment
States are acting quickly to ease some of the regulatory restrictions on treatment settings, using guidance from federal agencies as it becomes available. The Substance Abuse and Mental Health Services Administration (SAMHSA) this week released guidance for Opioid Treatment Programs (OTP), allowing states with declared emergencies, which currently include 48 states, to request blanket waivers to provide 28 days of take-home methadone for stable patients and 14 days for those who are assessed as less stable. Other states have disseminated or are in the process of disseminating changes in policy to their provider communities.
- New York’s Office of Addiction Services and Supports (OASAS) has asked all OTPs to consider taking a series of preventive measures, including utilizing take-home medications to reduce clinic traffic and encouraging clinics to explore ways to bring medications directly to individuals who are unable to leave their homes.
- Washington State, Colorado, and New Jersey have released guidance allowing blanket take-home medication exceptions of up to 14 days for patients who meet certain criteria – those with lab-confirmed COVID-19, respiratory symptoms, significant comorbid conditions (particularly those over age 60), and those who have already earned one additional take-home MAT dose. States are also encouraging OTPs to stagger clinic visit schedules to reduce the daily patient census.
- In a memo to Medicaid providers, Virginia delineated guidance for Office-Based Outpatient Treatment (OBOT) sites that include eliminating penalties for missed urine drug screens and psycho-social counseling.
- Under Maryland’s emergency declaration, behavioral health providers are exempt from the need to renew licenses during the emergency and are given a 30-day extension period to do so after the emergency ends.
- Maryland also released guidance for recovery homes and residential rehabilitation programs outlining social distancing recommendations, medication storage, and how to care for household members with COVID 19 who do not require hospitalization.
- SAMHSA’s communication also includes links to Ohio’s guidance document as an example of frequently asked questions that states and individual clinical sites can use to help patients understand how they can protect themselves and others and still access treatment medications.
- Several states, including Washington State and Colorado, have extended buprenorphine dosing requirements to one-per-week clinic visits with take-home doses available for new client outpatients.
Federal response to the pandemic related to OUD treatment is evolving daily. In just the past few days, important federal actions include:
- The Drug Enforcement Agency relaxed its long-standing requirement that buprenorphine induction be done in person, allowing providers to initiate a patient via telehealth services, and also waived regulations to allow for home delivery of medication to quarantined patients receiving MAT.
- Noting that they are “empowering medical providers to serve patients wherever they are during this national public health emergency,” the Office for Civil Rights within the Department of Health and Human Services announced that providers will be able to provide services remotely using technology that may not be fully compliant with the Health Insurance Portability and Accountability Act (HIPAA). Providers in states that have the reimbursement structures in place to deliver telehealth, particularly tele-behavioral health services, can expand these services and the platforms used to provide them.
People who are actively using drugs are at elevated risk of COVID-19 infection. Not only is equipment-sharing a potential source of viral spread, but drug use itself, particularly via smoking or injection, affects a user’s cardiovascular and pulmonary systems. Sudden withdrawal in the event that people with OUD cannot access substances causes a host of symptoms, some of which are similar to COVID-19 symptoms. A guidance document on COVID-19 for people who use drugs, available on the Connecticut’s Department of Mental Health and Addiction Services website, suggests that users stock up on both supplies to handle withdrawal and unused syringes and other equipment to mitigate potential COVID-19 transmission.
While syringe services programs are not available in all states, those that operate such programs can help individuals reduce their risk of COVID-19 infection. The national Harm Reduction Coalition has released guidance for individual programs, suggesting measures such as increased sanitization for sites, reduced staffing and volunteer time, and ensuring that participants have access to extra equipment when possible.
Navigating Behavioral Health Services during the Pandemic
The landscape of data, information, and guidance around COVID-19 is rapidly developing. Actions to focus resources to treat infection and slow the spread of COVID-19 are critical in this historic moment. As those measures are put into place, this pandemic also creates the need for states to consider policy levers to address urgent behavioral health issues. As further guidance in support of maintaining behavioral health services emerges, the National Academy for State Health Policy will continue to update states on these critical policy updates and opportunities.