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- Apr 9, 2020
- 12 min read

MAT Treatment Recommendations

Media Contact Adam Handelsman (512) 363-0594 adam@specopscomm.com

Nation’s Leading Drug Policy Experts Demand Medication Assisted Treatment and COVID-19: Treatment Reforms

During the COVID-19 pandemic, it is critical to remember that we are still in the midst of an overdose crisis. While many regulators have argued that methadone and buprenorphine policies must be deliberately restrictive due to the risk of overdose, adverse medication effects, and medication diversion, the COVID-19 crisis has forced many regulating bodies to re-evaluate these policies in order to comply with the urgent need for communities to practice social distancing and sheltering-in-place. Multiple government agencies including SAMHSA, the DEA, Medicare, and Medicaid have recently announced policy changes to allow for more flexible prescribing and dispensing. While these changes are a step forward, clinics have been either reluctant or resistant to fully implement them to the extent allowable under law. In light of the evolving pandemic and the needs of the community, we must not allow fears of overmedication and diversion to outweigh the health risks caused by patients being forced daily to congregate in large groups, or being driven to an adulterated illicit drug supply.

Close person-to-person contact and group assembly are currently actions deemed hazardous to public health. Unfortunately, “sheltering in place” is unrealistic for many people who use drugs. People who use opioids are either forced to continue to engage with the illicit drug market or must comply with prohibitive and insurmountable requirements to receive medications for Opioid Use Disorder (OUD). Many opioid users are at an increased risk of COVID-19 infection due to being immunocompromised and/or having comorbid health conditions.

In order to reduce the risk of COVID-19 infection, involuntary withdrawal, and drug poisoning, the Urban Survivors Union and the undersigned organizations strongly recommend the following measures be taken immediately:

1) The only acceptable standard for discharge of patients from OUD treatment during the COVID-19 outbreak shall be violent behavior that would endanger their own health and safety or that of other patients or staff.

2) Administrative detox shall be fully suspended during the pandemic and patients shall be provided the opportunity to request dose increases as needed, given that the illicit drug market will continue to experience fluctuations and patients need access to these life-saving medications. Patient doses shall not be reduced during the transition to take-home care unless they request adjustments to their doses, or documented medical emergencies require it and patients cannot consent due to medical crises, as may be the case with severe respiratory distress resulting from COVID-19 infection.

3) Referrals for COVID-19 testing shall be made available at all opioid treatment programs (OTPs), as well as syringe service programs. Staff shall receive training to recognize the symptoms of COVID-19 and be familiarized with protocols to refer patients for further testing. Harm reduction providers can also play an essential role in “flattening the curve” of transmission by identifying cases, making medical attention available to those who test positive, and teaching life-saving harm reduction skills to help people stay safe during this crisis. Plain language and evidence-based public health materials about COVID-19 prevention, symptom identification, and treatment should be available in locally prominent languages at all locations for participants and their communities.

4) During the COVID-19 national emergency, healthcare professionals–including doctors, nurse practitioners, physician assistants, and pharmacists–shall not be required to complete the previously-mandated training and waiver to prescribe these medications, thereby making MAT available in all settings. Prescribers shall not have limitations on the number of patients that they can treat. Naloxone and other overdose prevention tools (i.e. fentanyl test strips) shall be prescribed or made available with all dispensed medications in compliance with state law.

5) Opioid treatment programs (OTPs), prescribing clinicians, and pharmacies shall actively work to expand access to methadone treatment through the medical maintenance/office-based and pharmacy-delivery methods currently allowed by federal exception/waiver. The existing OTP regulations for the dispensing of MAT shall be temporarily adjusted to require all pharmacies to dispense these medications. This will reduce the risks of transmission associated with daily clinic attendance and person-to-person contact. In accordance with SAMHSA recommendations, lockbox requirements for take-home dispensing shall be suspended. Standard dispensing protocols for other opioid medications are deemed sufficient, since child- and tamper-proof bottles are already in use for methadone and buprenorphine. (Per SAMHSA’s TIP 43, Chapter 5: “Some programs require patients to bring a locked container to the OTP when they pick up their take-home medication to hold it while in transit. This policy should be considered carefully because most such containers are large and visible, which might serve more to advertise that a patient is carrying medication than to promote safety.”)

6) Take-home exception privileges shall be expanded to the maximum extent possible, limited only by available supply and operations for delivery. Any bottle checks that clinics wish to conduct shall be conducted by tele-medicine. Take-home schedules shall be authorized for individuals in all medical settings, including pharmacies and mobile vans. In light of new SAMHSA guidelines, clinics shall allow 14 to 28 days of take-home privileges to as many patients as possible. Patients testing positive for benzodiazepine or alcohol use shall be allowed the take-home privileges outlined in SAMHSA guidelines, but may be additionally required to check in via telemedicine for the purpose of decreasing the risk of adverse reactions, including overdose. Access to take-home doses is critical to keep patients engaged and retained in treatment.

7) Telehealth and service by phone shall replace any and all in-person requirements and appointments as the primary means of service provision until social distancing guidelines change. Toxicology requirements shall be suspended for the duration of telehealth-based services. Telemedicine services shall include waivered platforms, such as telephone intakes and video conferencing, as some patients may have different access needs.

8) The regulatory in-person requirements for methadone inductions shall be lifted in order to be consistent with the new policy changes for buprenorphine inductions. Clinic-based in-person appointments shall conform to social distancing requirements and OSHA guidelines for the management of the COVID-19 pandemic.

9) DEA restrictions on mobile medication units shall be revised to accommodate delivery of medications to individuals who are sequestered in their homes, are quarantined, or live in rural communities that are 15 miles or more from the nearest opioid treatment program.

10) State and federal Medicaid dollars shall be expanded to cover all costs for take-home medications not otherwise covered by insurance for patients experiencing financial hardship due to COVID-19. In states that did not expand Medicaid, the state shall be the payor of last resort.

In the interest of saving lives and adhering to existing public health protocol for management of COVID-19 transmission, it is necessary to make significant revisions to existing regulatory standards. This is a critical time to take decisive action for the protection of patients, providers, their families, and the community. As our healthcare system reaches full capacity and becomes overburdened by COVID-19-related emergencies, as seen in Italy and Spain, providers on the front lines will be forced to make life and death choices. These recommendations outline a plan of primary prevention that will minimize the burden on our healthcare system and save lives during this national emergency.

We, the undersigned, are a coalition of direct service providers, community advocates, public health officials, medical professionals, human rights groups, people in recovery, treatment professionals, members of impacted communities, and many others. We ask SAMHSA, the DEA, and all other federal, state, and local regulatory bodies and health authorities to adopt these recommendations fully and immediately in light of the COVID-19 pandemic.

Urban Survivors Union

Louise Vincent, MPH

Executive Director

National Harm Reduction Coalition

Monique Tula

Executive Director

The National Alliance for Medication-Assisted Recovery

Zachary Talbott, MSW

President

Joycelyn S. Woods, MA

Executive Director

Faces and Voices of Recovery

Patty McCarthy, M.S.

Chief Executive Officer

National Viral Hepatitis Roundtable

Lauren Canary, MPH

Director

Law Enforcement Action Partnership

Major Neill Franklin (Ret.)

Executive Director

The Levenson Foundation

Benjamin A. Levenson

Chairman

Foundation for Recovery

Dona M. Dmitrovic, MHS

Executive Director

National Council for Behavioral Health

Chuck Ingoglia

President and CEO

Drug Policy Alliance

Kassandra Frederique

Addiction Professionals of North Carolina

Sarah Potter, MPA

Executive Director

AIDS United

Drew Gibson, MSW

Policy Manager for HIV & Drug User Health

Alcohol & Drug Abuse Certification Board of Georgia

Amanda Finley

Executive Director

Alliance for Positive Health

Diana Aguglia

Regional Director

The BALM Training Institute for Family Recovery Services/Family Recovery Resources

Beverly A Buncher, MA, CBFRLC, PCC

Chief Executive Officer

Bay Area Workers Support

Maxine Holloway, MPH

Co-Founder

Benevolence Farm

Kristen Powers

Interim Executive Director

Better Life in Recovery/Springfield Recovery Community Center

David Stoecker, LCSW

Executive Director

BioMed Behavioral Healthcare, Inc

Brian A McCarroll DO. MS. ABAM

CEO, President

Brave Technology Coop

Gordon Casey

Deanna Dunn, PharmD

Owner/Pharmacist

The Middle East and North African Network of/for People who use Drugs

Hasan Taraif

Executive Director

Minnesota Recovery Connection

Wendy Jones

Executive Director

Movement for Family Power

Lisa Sangoi and Erin Coud

Co-Founders and Co-Directors

NCADD- NJ

Heather Ogden, CPRS, CRSP, CADC Intern

Advocacy Coordinator

Movement for Family Power

Lisa Sangoi and Erin Coud

Co-Founders and Co-Directors

NCADD- NJ

Heather Ogden, CPRS, CRSP, CADC Intern

Advocacy Coordinator

Suncoast Harm Reduction Project

Julia Negron, CAS

Founder and Lead Organizer

Tennessee Recovery Alliance

Sara Alese

Executive Director

Texas Drug User Health Alliance

Mark Kinzly

Executive Director

Texas Harm Reduction Alliance

Joy Rucker

Co-Chair

Suncoast Harm Reduction Project

Julia Negron, CAS

Founder and Lead Organizer

Tennessee Recovery Alliance

Sara Alese

Executive Director

Texas Drug User Health Alliance

Mark Kinzly

Executive Director

Texas Harm Reduction Alliance

Joy Rucker

Executive Director

Texas Harm Reduction Conference

Emily Gray

Co-Founder

Texas Overdose Naloxone Initiative

Mark Kinzly

Executive Director

Truth Pharm

Alexis Pleus

Executive Director

Ukrainian Network of People who Use Drugs

Anton Basenko, ME

Chair of the Board

Michelle Accardi-Ravid, Ph.D., Clinical Psychologist, Acting Assistant Professor, University of Washington Medical Center/ Harborview Medical Center

Chris Alba, Harm Reduction Specialist, Health Innovations Inc

Onyinye Aleri, Case Manager, Charm City Care Connection

Sarah Baranes, MD Candidate

Anton Basenko, ME, Country Focal Point: PITCH, Alliance for Public Health

Donna Beers, MSN, RN-BC, CARN, Boston Medical Center

Leo Beletsky, J.D., MPH, Health in Justice Action Lab, Northeastern University

Patricia Bellucci, Ph.D., Clinical Psychologist/Psychoanalyst

Daniel Bibeau, Ph.D., Professor of Public Health Education, University of North Carolina, Greensboro

Michler Bishop, Ph.D., Associate Professor, Director, Alcohol and Substance Abuse Services, Albert Ellis Institute, NY

Ricky N. Bluthenthal, Ph.D., Keck School of Medicine, University of Southern California

Elizabeth Bowen, PhD, Assistant Professor, University at Buffalo School of Social Work

Jennifer J. Carroll, Ph.D., MPH, Assistant Professor, Elon University

INDIVIDUALS

Sharon Chancellor, CSAC

Managing Director, Policy Advocacy & Campaigns

International Certification & Reciprocity Consortium

Crystal Smalldon, CCAC, CIAC, RSSW

President

Behavioral Health Association of Providers

Pete Nielsen, MA, LAADC

CEO

Center on Addiction / Partnership for Drug-Free Kids

Frederick Muench, Ph.D.

President

National Advocates for Pregnant Women

Lynn M. Paltrow, J.D.

Founder and Executive Director

Recovery Advocacy Project

Ryan Hampton

Organizing Director

Open Society Foundations

Sarah Evans

Unit Manager, Public Health Program

Kasia Malinowska-Sempruch

Director, Global Drug Policy Program

305 Psychotherapy Group

Mark Houston, LCSW

Owner and Psychotherapist

Broken No More

Tamara Olt, M.D.

Executive Director

CADA of Northwest Louisiana

Bill Rose, LAC, CCS, CCGC

Executive Director

C4 Recovery Foundation, Inc.

Ricard Ohrstrom, Chairman

Jack O’Donnell, CEO

Center for Optimal Living

Andrew Tatarsky, Ph.D.

Executive Director

Center for Popular Democracy/ Opioid Network

Jennifer Flynn Walker

Senior Director of Advocacy and Mobilization

Central Texas Harm Reduction

Richard Bradshaw

Community Outreach Leader

CheckUpandChoices.com

Reid K Hester, Ph.D.

Director, Research Division

Chicago Drug Users Union

Peter Moinichen, CADC, CODP, MAATP

Co-Founder

Chicago Recovery Alliance

Brandie Wilson

Executive Director

Choices Recovery Trainings

Ginger Ross, CRSW, NCPRSS

Owner/Trainer

Church of Safe Injection

Kari Morissette

Families for Sensible Drug Policy

Carol Katz-Beyer

President

Florida Opiate Coalition- Block by Block

Albert Park, MSW

Co-Founder

International Network of People Who Use Drugs

Judy Chang

Executive Director

Illinois Association of Behavioral Health

Sara Howe, MDA

Co-Chairperson

North American Syringe Exchange Network/ Tacoma Needle Exchange

Paul A. LaKosky, Ph.D.

Executive Director

North Carolina Harm Reduction

Shelisa Howard-Martinez

Executive Director

North Carolina Survivors Union

Louise Vincent, MPH

Executive Director

Northern Berkshire EMS

Stephen Murray, BBA, NRP

Paramedic Supervisor

ONESTOP Harm Reduction Center, North Shore Health Project

Mary Doneski, MA

Program Manager

Reframe Health and Justice

Sasanka Jinadasa

Partner

Rights & Democracy NH, Rights & Democracy VT, Rights & Democracy Institute

Kate Logan, MA/ABD

Director of Programming & Policy

R Street Institute

Carrie Wade, Ph.D., MPH

Director of Harm Reduction Policy

Chelsea Boyd, MS

Research Associate Harm Reduction Policy

San Francisco AIDS Foundation

Laura Thomas, MPH, MPP

Director of Harm Reduction Policy

The Seven Challenges LLC

Robert Schwebel, Ph.D.

Author and Program Developer

Sex Worker Advocacy Coaltion

Tamika Spellman

Lead Organizer

Sex Workers Outreach Project Behind Bars

Jill McCracken, Ph.D.

Co-Director

Sex Workers Organizing Project- USA

Christa Daring

Executive Director

The Southern Tier AIDS Program

John Barry, LMSW

Executive Director

Students for Sensible Drug Policy

Betty Aldrich

Executive Director

University of Missouri, St. Louis

Missouri Institute of Mental Health

Claire Wood, Ph.D.

Rachel Winograd, Ph.D.

Addiction Science Faculty

Urban Survivors Union, Greensboro Chapter

Derek McCray Miller

Member

Dr. Vando Medical Services

Leonardo Vando, MD

Chief Executive Officer

Vantage Clinical Consulting LLC

Jamelia Hand, MHS, CADC, CODP

Chief Executive Officer

Vermonters for Criminal Justice Reform

Thomas Dalton, J.D., MA, LADC

Executive Director

VICTA

Lisa Peterson, LMHC, LCDP, LCDS, MAC

Chief Operating Officer

Voices of Community Activists and Leaders- New York

Jeremy Saunders

Executive Director

Whose Corner is it Anyway

Caty Simon

Founding Co-Organizer

Women With A Vision

Christine Breland Lobre, MHS, MPH, LPC

Program Director

Zanzibar Network of People Who Use Drugs

Kassim Nyuni

Executive Director

Christie Chandler, MA, QP, North Carolina Harm Reduction Coalition

Hong Chen Chung, MD, MPH, Medical Consultant, Community Action Programs Inter-City, Inc

Seth Clark MD, MPH, Assistant Professor of Medicine and Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University

Kelley Cohill, LCSW-C

Susan E Collins, Ph.D., Co-Director, Harm Reduction Research and Treatment Center

Erica Darragh, Board Member, Students for Sensible Drug Policy; Chapter Director, DanceSafe

Jane Dicka, Health Promotion Team Coordinator, Harm Reduction Victoria

Mary Doneski, Program Manager, ONESTOP Harm Reduction Center

Patt Denning, PhD, Director of Clinical Services and Training, Harm Reduction Therapy Center

Cathy Dreifort, Harm Reduction Outreach Specialist, Shot in the Dark

Andria Efthimiou-Mordaunt MSc, Coordinator, John Mordaunt Trust

Nabila El-Bassel PhD, Director, Social Intervention Group

Taleed El-Sabawi, Assistant Professor, Elon University School of Law

Jennifer I. Healy, Former Director, Bcbsma, Board Member, The Global Recovery Movement

Robert Heimer, PhD, Professor of Epidemiology, Yale School of Public Health

David Himmelstein, MD

Robert Hofmann, U.S. Movement Building Fellow, Students for Sensible Drug Policy

Heather Howard, Ph.D., Assistant Professor, Florida Atlantic University

Sheila Humphrey, Dayton Director, Harm Reduction Ohio

Lauren Jessell, MSW, Senior Research Associate

Sterling Johnson, Esq., Organizer, Black and Brown Workers Cooperative

Carol Jones, Director of Harm Reduction, Alliance for Living

Ashley Jordan, Adjunct Assistant Professor, City University of New York

Sharon Joslin, APRN, Director, Community Health Care Van, Yale University School of Medicine

Norty Kalishman, MD

Mary E. Kelly, PsyD, Psychologist

Stefan Kertesz, MD, Professor, University of Alabama

Jennifer L Kimball, Berkshire Opioid Addiction Prevention Collaborative

Regina McCoy, MPH, MCHES, NBC-HWC, Professor, UNC Greensboro

Ryan McNeil, Ph.D., Assistant Professor & Director of Harm Reduction Research, Yale Program in Addiction Medicine, Yale School of Medicine

Nancy Mullin, MA, PsyD Graduate Student, California Institute of Integral Studies

Alicia Murray, DO, Addiction Psychiatrist, General Psychiatrist

Ethan Nadelmann, Founder and former Executive Director, Drug Policy Alliance

Daniel Nauts, MD, FASAM, Consultant/trainer, Montana Primary Care Association

Tammera V Nauts, LCSW, LAC, IBH Director, Montana Primary Care Association

Tracy R. Nichols, Ph.D., Department of Public Health Education, University of North Carolina, Greensboro

Danielle C. Ompad, Ph.D., Associate Professor, New York University School of Global Public Health

Caitlin O’Neill, Director of Harm Reduction Services, New Jersey Harm Reduction Coalition

Dinah Ortiz, NCSU Board Member

Bayla Ostrach, MA, PhD

Steven Pacheco, Program Officer, Circle for Justice Innovations Fund

Vanessa Santana, Recovery Coach, Turning Point Recovery Center

Carolyn Sartor, Ph.D., Associate Professor, Yale School of Medicine

Roxanne Saucier, MPH

Jacob Schonberg, CPSS, Social Work Practitioner, UNC School of Medicine

Mark Schulz, Associate Professor, University of North Carolina, Greensboro

Mandy Sladky RN, MSN, CARN, Opioid Project Manager and OBOT RN, Public Health Seattle & King County

Samuel Snodgrass, Ph.D., Board Member, Broken No More

Nicole Spector, RN, BSN, Health Innovations Inc

Annie Steinberg, President, GW Chapter Students for Sensible Drug Policy

Dr. Laura Stern, Sage Neuroscience Center

Janet K Stoltenborg, MS, MBA, Member, Moms for All Paths to Recovery from Addiction

Phillip Stracener, NCCPSS, BSW, Harm Reduction Specialist, AIDS Leadership Foothills-Area Alliance

Gabi Teed, BSW, CRSW, Perinatal SUD Care Coordinator, Amoskeag Health

Matthew Tice, LCSW, Pathways to Housing PA

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