Opioid treatment programs are now working through concurrent health crises.
Patients rely on the facilities for obtaining medication-assisted treatment. But providers are trying to reduce the number of in-person visits and the risk of patients being exposed to COVID-19.
"The reality is, the opioid crisis has not gone anywhere," said Allegra Schorr, president of the Coalition of Medication-Assisted Treatment Providers and Advocates of New York State. "These two crises crashing into each other is the big fear."
To help ease some of the strain, opioid treatment programs have turned to telemedicine and take-home doses of medications.
Dr. Jonathan Samuels, head of the addiction medicine program at SBH Health System, said SBH has more than 600 patients who are prescribed methadone, Suboxone or a Vivitrol injection. The program has upped the number of extended doses for patients, but the effort has been a balancing act of individually assessing the risk of overdose with that of contracting and having severe complications from Covid-19.
SBH is staggering in-person visits to reduce patients in the waiting room and offering telephone visits.
Dr. Harshal Kirane, medical director and assistant professor of psychiatry at the Zucker School of Medicine at Hofstra/Northwell, is navigating the Covid-19 outbreak as he gets ready to open Wellbridge Addiction Treatment and Research in Calverton, Long Island, in May.
We, over the last two decades, have had an incredibly complex drug and alcohol crisis with tremendous implications for the mental health needs of Americans," Kirane said. "The Covid-19 outbreak is only going to intensify some of the underlying fractures in the framework of how people manage mental health issues."
Dr. Joel Idowu, chairman of the Department of Psychiatry and Behavioral Health Sciences at Richmond University Medical Center, echoed the importance of telemedicine. The loosened regulations on initial visits for treatment have been particularly helpful, he said.
The entire healthcare industry is facing workforce shortages. Though telehealth has helped to ease some of the strain, providers at opioid treatment programs are working through their own health concerns and child care issues.
Schorr noted that some hospital-based programs have been asked to redeploy doctors, nurses and staff to other parts of the facility during the pandemic. She added that the association is working with the city and the state to try to come up with ways to fill some of the gaps in addiction treatment.
For stable patients, take-home doses of medication are essential, she said. The association recently detailed the importance of reimbursement reforms for at-home doses in presenting Medicaid redesign recommendations to the state.
However, it's those patients who are early in their treatment and who have other health problems that opioid treatment programs are most worried about, Schorr said, especially as anxieties rise and coping mechanisms may be sought.
This article was originally published in Crain's New York Business.