Bold action will avoid patients congregating in clinic lobbies and parking lots
State pharmacy orders 28,000 additional Narcan kits
UPDATE: Most methadone clinics won’t get Narcan from the state until Monday. That’s longer than we would have liked. It means it took the state two weeks to make take-home doses happen during the coronavirus emergency.
The state of Ohio is preparing to send 12,000 Narcan kits to the state’s 60 methadone clinics so patients can start receiving extended take-home doses of medicine that will help patients reduce social contact during the COIV-19 threat.
The state announced a week ago that it had approved extended take-home doses that would let patients take home enough medicine to last for a few days or, in some cases, as long as 28 days. The goal was to end the practice of methadone patients having to congregate in the early morning in clinic lobbies and parking lots to methadone doses often lasting only one day.
However, the state’s plan never got off the ground because because the state ordered that, to get a take-home dose, patients had to possess naloxone (brand name:Narcan) but provided no access to extra naloxone for clinics or patients. It was a classic Catch-22: The state ordered that patients and clinics have massive volumes of Narcan but made none available.
The result was little changed: large crowds still gathered at methadone clinics every morning, a state-required contradiction of the state’s own policy not to gather in groups.
Harm Reduction Ohio started advocating for the state to supply methadone patients the needed Narcan or rescind the requirement that patients needed it to obtained extended doses. Harm Reduction Ohio, which operates a statewide Project DAWN program authorized to furnish naloxone, offered to handle the Narcan deliveries itself if the state provided the needed Narcan.
On Monday, the state agreed to fix the problem by shipping Narcan directly from state’s central pharmacy to all Ohio methadone clinics. The state pharmacy would use its current inventory of nearly 12,000 Narcan kits to cover the needs of the state’s methadone clinics. In addition, the state ordered 28,000 additional Narcan kits to cover orders that exceeded its inventory or was needed for other purposes, such as the online naloxone ordering program operated by Harm Reduction Ohio with state support.
DeWine administrations fixes glitch in coronavirus response
“I want to thank everyone in state government for taking extra steps to protect the health of methadone patients in Ohio,” said Harm Reduction Ohio President Dennis Cauchon. “Methadone patients are a stigmatized population that is often overlooked or dismissed — but not this time. As busy as it is dealing with a pandemic, Gov. DeWine’s administration made its coronavirus policy of social isolation work at the ground level, not just from the podium.”
Alisha Nelson, director of RecoveryOhio and the governor’s top drug policy advisor, was particularly instrumental in connecting all the threads and all the government departments to find a solution, Cauchon said. “She kept her cool and her eye on a solution even when things got testy, toes were stepped on and a considerable amount of money needed to be spent,” Cauchon said.
The state pays $75 per Narcan kit, cheaper than the drug store price of $110 per kit but still close to $1 million for 12,000 kits headed to methadone clinics and $2 million for the additional Narcan purchases. Much of the Narcan will be purchased with federal money from the state Opioid Response grant provided to Ohio to response to our state’s high level of opioid overdose deaths.
Methadone: an increasingly important treatment in Ohio
Methadone is a long-lasting opioid that is used treat opioid use addiction. Most patients using methadone previously injected heroin or fentanyl.
Methadone is the most effective opioid treatment for reducing overdose death and other problems. However, it has been heavily regulated by the federal government since the 1970s and carries more stigma that its primary alternative, buprenorphine, usually sold in Ohio as Suboxone, a combination buprenorphine and naloxone.
Ohio has worked hard — and successfully — in the last two years to increase the number of methadone clinics in Ohio. The most recent federal list of methadone clinics reported 58 facilities in operations, more than double the number in 2017. Several fast-growing, for-profit treatment companies — Brightview, Pinnacle and Premier — offer high-quality, harm reduction-friendly clinics, often in small cities, from Batavia to Zanesville, that have expanded treatment options dramatically in Ohio.
Ohio has an estimated 15,000 to 25,000 patients receiving methadone treatment. Methadone can cause overdose death, especially when taken in overly large doses or mixed with other drugs such as Xanax or alcohol. Overdose risk rises when patients get access to greater amounts of doses, as occurs with extended take-home doses.
Overdose risk vs. coronavirus transmission risk
Although the number of take-home doses a patient receives is up to that patient’s physician, the new federal-state guidelines permit take-home doses of up to 28 days for stable patients who have been using methadone for a while. Newer patients who have not established a stable dose level can get up to 14 days worth of take-home doses.
The must-have naloxone rule for extended take-home doses is not unreasonable but become so when no naloxone was available, forcing patients to come in as often as daily for each dose during a pandemic threat.
The methadone population suffers from a lack of immunosuppression and is particularly vulnerable to COVID-19. As former IV drug users, many methadone patients also have HIV, Hepatitis C and other viral infections. A large share smoke cigarettes as well, another risk factor for dying from the coronavirus.
This is the Ohio Department of Mental Health and Addiction Services guidance released March 24 on how methadone clinics can obtain Narcan.