Long before the Covid-19 pandemic had reached its current proportions, we talked about the major problems that existed in the outpatient methadone rehab industry, including problems with outpatient methadone rehab in Florida. Many of those problems are caused by policies that were intended to fight against issues that do not exist. Let me give you a few examples. Before outpatient methadone rehab was widely adopted, people who were unfamiliar with the research on methadone were scared that patients would sell their own methadone doses if given the chance. In reality, it makes very little sense for patients to engage in that activity, as the relatively cheap doses of methadone would have to be replaced with expensive opioid drugs from illicit sources. To put it bluntly, it would be crazy to sell 12 dollars of methadone and then go purchase 100 dollars’ worth of heroin to make it through the day without feeling sick. We also have research that tells us that the practice is rare regardless. Another fear of some people was that people would not take their medication unless they were being watched by a nurse when she dispenses the daily dose of medication. This theory suffers for the same reasons. The relatively cheap and highly beneficial dose of methadone that a patient is taking would have to be replaced with something more expensive and more dangerous. The process of giving individual doses to many patients every single day is even more ridiculous when you consider the disruption it causes to the lives of people in the programs.
Because of bad theories, including these two, patients who are being treated in an outpatient methadone rehabilitation program are forced to go to the clinic every day for a single dose. This can cause huge problems for anyone with a job, children, school, or anything else important to do. Covid-19 has changed things for methadone clinics and the people who make the rules. Having hundreds or even thousands of patients report to the same place every day to get single doses is lunacy during a viral pandemic, although there is still some of that going on. Many clinics have been allowed to give people take-home doses sooner after they begin treatment, and they are able to increase the total number of patients that get take-home doses as well. This is a welcome change for both patients and staff, but it can be life-changing for many of the patients. With little reason for the strict rules in the first place, many people who work around medication-assisted treatment (MAT) have been wondering if changes made because of Covid-19 could offer the government some proof of concept for doing things differently in the future. I came across one study called “Increased flexibility in methadone take-home scheduling during the COVID-19 pandemic: Should this practice be incorporated into routine clinical care?” An important factor in possibly making the changes to the outpatient methadone rehab system permanent will be research proving that the new concept is sounder than going back to the old status quo. The study points at the benefits of take-home medication during the pandemic, for a variety of different reasons, but the authors of the study go further than just that. They go on to state that “we should consider maintaining the take-home practices that we adopted in response to the pandemic, even after the pandemic has abated.” This helps reinforce what many people already knew, including the people I know that work in MAT programs in Florida, and other people that I have talked to who work around outpatient methadone rehab.
By T.A. Cannon (Contact me at TACannonWriting@gmail.com)
TRUJOLS, J. et al. Increased flexibility in methadone take-home scheduling during the COVID-19 pandemic: Should this practice be incorporated into routine clinical care? Journal of substance abuse treatment, [s. l.], v. 119, p. 108154, 2020. DOI 10.1016/j.jsat.2020.108154. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=33032860&authtype=geo&geocustid=s8475741&site=ehost-live&scope=site. Acesso em: 4 dez. 2020.