Opioid treatment providers are hailing changes to the federal rules governing the administration of methadone as a “game changer” that will save lives and help people in recovery stay away from opioids.
On Feb. 1, the U.S. Department of Health and Human Services made permanent initiatives implemented during the pandemic, such as allowing patients to self administer doses at home and receive treatment via telehealth. In addition, it is allowing providers to prescribe higher initial methadone doses to prevent withdrawal and relapse, particularly for patients exposed to fentanyl. The dosage had been set at 30 mg.
“As treatment providers, we have been literally begging for these changes. To be able to treat this disease in a clinically effective way is so exciting. I’m ecstatic,” said CODAC President and CEO Linda Hurley.
What’s changed about the availability of methadone?
The changes are intended to “dramatically expand access to life-saving medications for opioid use disorder … and to reduce stigma,” according to the federal agency. They also have removed stigmatizing and outdated language.
“Medications to treat opioid use disorder are the gold standard for saving lives and reducing overdoses. The new SAMHSA rule changes will provide improved access to services and medications in a way that we have never seen before,” Linda Mahoney, of the state’s Opioid Treatment Authority, said in an email. “For some people, this will reduce the need to go to the clinic every day, providing more time in people’s lives to get to work, take care of children or just do normal day-to-day things without worry.”
It was the first substantial change to Substance Abuse and Mental Health Services Administration’s regulations in two decades. They are part of the Health and Human Services Overdose Prevention Strategy. The new rules take effect April 2, with Oct. 2 as the date to comply.
`One little relapse today can kill’
Previously, patients had to receive doses daily at one of the state’s 17 clinics, posing hurdles for people juggling jobs and families, as well as transportation struggles for some.
“Opioid treatment clinics have always been stigmatized. It was interfering with life and it’s a risk to a patient’s recovery,” Hurley said. “Now, we don’t have to make them come every single day.”
Research has shown that patients receiving take-home doses are more likely to remain in treatment and less likely to use illicit opioids, according to federal officials.
Hurley said the 30-mg limitation on the initial dose left patients uncomfortable and experiencing symptoms of withdrawal, particularly if they had been using fentanyl.
“It’s not safe if people are uncomfortable. People are going to use if they are uncomfortable,” she said, adding “One little relapse today can kill.”
In 2022, 436 Rhode Islanders died from accidental drug overdoses.
Evidence in Rhode Island showed that the increased flexibility put in place during the pandemic did not result in methadone being diverted onto the streets, Hurley said.
“We didn’t see any increase in arrests for possession of methadone,” South Kingstown Police Chief Matthew Moynihan said Friday. Moynihan is involved in the HOPE Initiative, an outreach program in which law-enforcement officers pair with substance-use specialists to connect people with treatment and resources within 72 hours of an overdose.
He said he reached out, too, to Cranston Police Chief Michael J. Winquist, who also had not seen an increase in his city.
`They don’t miss doses’
The changes also give nurse practitioners and physician assistants the authority to prescribe opioid treatment medications to increase patient access. A doctor previously had to review every prescription, resulting in delays in care, Hurley said.
The acuity of a patient’s need determines the amount of methadone they are given to take home and the frequency of telehealth and in-person visits, Hurley said.
Currently, 5,871 individuals are receiving methadone at one of Rhode Island’s 17 opioid treatment locations, according to Randal Edgar, spokesman for the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals.
Another 5,106 Rhode Islanders had a buprenorphine prescription as of the fourth quarter of 2023, Edgar said.
“They don’t miss doses. That’s stability,” Hurley said. “[The new rules] are game changers.”
Going forward, people can be prescribed buprenorphine without a face-to-face appointment by calling the Rhode Island Buprenorphine 24/7 Hotline: (401) 606-5456.