COVID-19 and Opioid Addiction Treatment.

• Author: Bose, Feler
• Position: BRIEFLY NOTED

The COVID-19 pandemic has changed the treatment of addictive disorders. Until this year, most patients using methadone to treat opioid addiction were required to visit a clinic daily to receive the medication, although tightly controlled take-home doses were allowed for a small number of patients. That highly regulated and rigid treatment model was inconvenient for most patients but lucrative for the clinics.

Today, a majority of the methadone clinics are operated by for-profit corporations and comprise one of the most lucrative businesses in the field of drug treatment. Any attempt to change this model has been opposed by the clinics. As a result, the treatment of opioid addiction remains firmly separate from "normal" medical practice, which generally pursues more convenient options for patients, like being seen in a medical office.

COVID-19 and the requirement for social distancing prompted the federal Substance Abuse and Mental Health Services Administration (SAMHSA) to temporarily relax the rigid requirements of patients standing in line outside methadone clinics for their daily dose. SAMHSA has allowed methadone clinics to give patients 15-30 days of methadone to take at home. These relaxed rules should continue after the pandemic ends. The treatment of opioid addiction should be reintegrated into mainstream medical practice.

History / Methadone was originally developed in Germany during World War II as a synthetic opioid to alleviate an acute shortage of morphine. Methadone is relatively long-acting, with an effective half-life of 24 hours compared to about four hours for the opioid heroin. Metha done thus can be used to treat addiction to other opioids by helping addicts to detoxify or at least transition away from more dangerous drugs. Under a 1974 presidential order, methadone came into use as a treatment for patients addicted to heroin, including soldiers who became addicted to heroin while fighting the Vietnam War. The methadone clinic model was also codified in 1974 with the passage of the Narcotic Addict Treatment Act, which requires patients to receive methadone on a daily basis in a strictly regulated setting.

An alternative / Many opioids--including methadone--cause dose-related respiratory depression that can result in death at high doses. Buprenorphine, an opioid developed in the 1970s as a potent analgesic for post-operative pain, is characterized by a "ceiling" effect on respiratory depression: as the dose increases...