Methadone on the phone: Virtual addiction treatment weighed

Health

FILE—Vanessa Caudel, a nurse, sits at her work station in the Great Circle treatment center on Feb. 24, 2022, in Salem, Ore., where she provides doses of methadone, which can relieve the “dope sick” symptoms a person in opioid withdrawal experiences. (AP Photo/Andrew Selsky, File)

(NewsNation) — Recovering opioid users who rely on the drug methadone can face transportation challenges to make daily appointments, particularly in rural areas, with some having to drive hours to reach the nearest clinic.

But shutdowns due to the pandemic brought a silver lining for some opioid use disorder patients, who were able to take treatment at home, monitored via video chat.

Federal regulators waived addiction telehealth restrictions due to COVID-19 in favor of allowing appointments to be done virtually, but making these changes permanent is currently a topic of debate.

Methadone is among the most effective treatments for opioid addiction. It’s a weaker opioid that reduces cravings while allowing the person to function better.

Because methadone is a controlled substance, traditionally it has to be taken in person, daily, at clinics. Patients often had to jump through hoops to take home doses or were outright denied the ability to do so, resulting in people dropping out of treatment. 

Pandemic regulations allowed some patients to take the drug home, and administer it themselves, while a doctor watched them do it on a video chat.

Danielle Russell — who researches how changing pandemic regulations impact people taking methadone — said she was hopeful the changes to telehealth would make what was stigmatizing, time-consuming and inconvenient more safe, private and consistent. She also has been a methadone user for 15 years.

“I was like, ‘Oh, my God, this is wonderful, is going to be so great for so many people,’” she said. 

For some, these efforts seemed to have worked. When patients were allowed to take doses home, researchers found 88% completed virtual treatment, an increase of at least 14% from before the pandemic. Meanwhile, the likelihood of overdose or death didn’t increase. 

However, the implementation was inconsistent for many patients.

Researchers found a majority of clinics allowed the providers to attend the appointments virtually, but still required patients to visit crowded clinics to use the computers on location. 

“It seems that providers weren’t centering client needs, they centered their own needs,” Russell said. 

A substantial number of methadone users called the policies “degrading and dehumanizing,” saying restrictions made it more difficult to meet their daily responsibilities. Those could include jobs with inflexible schedules, lack of child care, or inability to pay high gas costs. Russell said she heard this from her research and experienced it herself. 

“The provider is at home safe, and I’m after waiting in the clinic for like an hour to see them at this computer,” Russell said. “That’s how they … implemented telehealth — so we didn’t get the benefit or the safety of being able to use it at home.”

The daily routine of going into a clinic is an “antiquated” system, said Robert Pack, director of the Rural Health Equity Research Center.

“We have people coming from far and wide (because of) the lack of access in their local areas … folks that don’t have a whole lot of resources and getting to appointments can be very, very challenging,” Pack said.

Some have argued that allowing doctors to work remotely could increase the reach of specialists into areas where it’s hard to recruit doctors.

Meanwhile, the complexities of state and federal regulations may make many clinics hesitant to increase access to two-weeks’ or a month’s supply of take-home doses.

Many drug users say more guidance and financial support from the federal government will be key to making sure rural patients can get the life-saving medicines they need — especially if telehealth policies go from temporary to permanent as expected.

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