During the COVID-19 pandemic, several major developments transformed clinical and operational practices in OTPs. Beginning in March 2020, and under emergency exemption policies promulgated by SAMHSA in collaboration with the State Opioid Treatment Authorities (SOTAs), OTPs were approved to provide more take-home medications to patients. Forty-two states filed for emergency exemption requests for take-home medication; published reports are referenced in this paper.[10] Markedly few reports of misuse are seen in take-home medication given the scope and number of increased take-home medication. Many of the OTPs in the United States suspended toxicology screenings to protect the safety of the staff and patients. However, more toxicology reports were found to be positive with heroin and fentanyl once OTPs reinitiated testing. Fortunately, few reports of methadone related overdoses were attributable to patients consuming take-home medication prematurely. This development has opened the door to rethinking how take-home medication can be implemented with greater flexibility in treating clinically stable and unstable patients. SAMHSA also needs to make clearer distinctions with regard to clinically unstable patients if there is any attempt to reevaluate the existing regulatory criteria for dispensing take-home medications.

 

We believe SAMHSA’s OTP regulatory oversight policies should be cautiously reevaluated and based on evidence and clinical practice. Clearly, OTPs need to have greater flexibility to make ongoing care less burdensome for the patient. The COVID-19 pandemic also compelled OTPs to be more creative in providing patient care. The “real-world” experience of OTPs clinician and patients makes a case that SAMHSA consider a change in take-home requirements.

During the COVID-19 pandemic, several major developments transformed clinical and operational practices in OTPs. Beginning in March 2020, and under emergency exemption policies promulgated by SAMHSA in collaboration with the State Opioid Treatment Authorities (SOTAs), OTPs were approved to provide more take-home medications to patients. Forty-two states filed for emergency exemption requests for take-home medication; published reports are referenced in this paper.[10] Markedly few reports of misuse are seen in take-home medication given the scope and number of increased take-home medication. Many of the OTPs in the United States suspended toxicology screenings to protect the safety of the staff and patients. However, more toxicology reports were found to be positive with heroin and fentanyl once OTPs reinitiated testing. Fortunately, few reports of methadone related overdoses were attributable to patients consuming take-home medication prematurely. This development has opened the door to rethinking how take-home medication can be implemented with greater flexibility in treating clinically stable and unstable patients. SAMHSA also needs to make clearer distinctions with regard to clinically unstable patients if there is any attempt to reevaluate the existing regulatory criteria for dispensing take-home medications.

 

We believe SAMHSA’s OTP regulatory oversight policies should be cautiously reevaluated and based on evidence and clinical practice. Clearly, OTPs need to have greater flexibility to make ongoing care less burdensome for the patient. The COVID-19 pandemic also compelled OTPs to be more creative in providing patient care. The “real-world” experience of OTPs clinician and patients makes a case that SAMHSA consider a change in take-home requirements.