Covid-19 has freed opioid addiction patients from daily methadone clinic visits

 There are many ways in which Covid-19 has dramatically worsened the US opioid epidemic.

Routines are disrupted. Support networks inaccessible. Harm reduction services, such as needle exchanges, are closed. Opioid overdoses are up, opportunities for treatment fewer, and research is all but halted.

But despite the many setbacks, the pandemic is also pushing some necessary innovations in the treatment of opioid addiction disorder. Among the the most revolutionary is rethinking the need for daily visits to methadone clinics.

Prior to the pandemic, patients who were treated with methadone had to receive daily doses at the nearest methadone clinic, long the established standard of treatment. "This practice was predicated on the belief that you can't trust the patient, that if the patient is given more than the daily doses that they'll overdose," says Nora Volkow, the director of the National Institute on Drug Abuse (NIDA).

Patients would then progressively acquire so-called "bottle privileges," or the ability to take home extra bottles of methadone--which comes in daily bottle doses--and go to the clinic every other day, or once every three days. Prior to Covid-19, that was a very slow process, requiring at least two years to build up to a one-week supply. "It could be a period of years for someone to build up to have two weeks of take-home bottles," says Kenneth Morford, an assistant professor of medicine at Yale who specializes in opioid addiction treatment in his clinical practice.

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