Opioid treatment programs continue to respond to the evolving needs of our patients throughout the first wave of this epidemic. These developing responses can be viewed as inflection points or stages. The first stage, beginning six or seven weeks ago, represented the initial shock to the system with conservative decision making. This gave way to a more adaptive responses through more flexible policy making at federal and state regulatory levels in addition to changing program policy.
The second stage represented increasing adaptability as more take-home medication was provided in addition to curbside administration of medications and providing families or friends of patients with take-home medication, following patient consent.
Without any question, this epidemic has provided different challenges to the OTPs. On the one hand, if OTPs were overly conservative in providing take-home medication to patients, there would be increased risk of infection. On the other hand, if the OTPs provided too much additional medication to clinically unstable patients, there would be additional risk for potential overdose and diversion.
This is why we discussed this balancing in our Association’s initial guidance to our field, which was released on March 20, 2020.
There were the initial complications, including the assurance that there would be an adequate supply of medication as OTPs began submitting larger than normal orders of medication. Fortunately, this challenge was quickly resolved through the DEA and pharmaceutical manufacturers. There has been no interruption in the supply of needed medication for OTPs.
OTPs were also experiencing difficulty in obtaining personal protective gear and SAMHSA was extremely helpful in providing a letter on March 25, 2020, which helped free up some supplies. Additionally, the White House Office of National Drug Control Policy also provided a letter to the field on April 23, 2020 and that has also been helpful in getting protective equipment to OTPs since there continues to be challenges in obtaining masks and other protective equipment. I am grateful to have the support of these federal agencies in providing guidance to our field as OTPs remain open as essential medical facilities.
We are now facing a new, third stage and I anticipate that there will be greater reports of patient and staff infection and mortality. We will begin collecting such information over the next several weeks in conjunction with our policymaking partners. There will come a time where we will be better able to understand what went right and what did not, and we will come to know how OTPs acted in response to the needs of our patients.
The dust has yet to settle but it is important to acknowledge the incredible work of the staff working in OTPs in addition to expressing gratitude to the patients, who continue to put their trust into the work of our treatment programs during such an extraordinarily challenging time. I realize that some programs may have been slow to react to the initial shock of the first wave and I believe that that there has been an evolution of thoughtful responses. There will be many people to thank in the coming months as the initial phase of this epidemic comes to an end and AATOD will continue to provide guidance to the field as we learn more.
For the time being, I am deeply appreciative of the work of the OTPs and other substance use treatment programs throughout our country and other nations. I am also grateful for the coordination of the federal and state agencies, which have jurisdiction in these areas.
In good health,
Mark W. Parrino, M.P.A. – AATOD President
Written and posted May 1, 2020, can be found on the AATOD web page at http://www.aatod.org
