COVID-19: Treatment Recommendations from the Urban Survivors Union and signatories

For SUD services providers, recovery services providers, and drug user health advocates 

Read and consider this open letter to OUD care providers and government agencies. Email Michael Gallipeau at mikeyg@urbansurvivorsunion.org to add your/agency's signature.

For the Media 
 

Contact Adam Handelsman

(512) 363-0594

adam@specopscomm.com

Nation’s Leading Drug Policy Experts Demand Medication Assisted Treatment and COVID-19: Treatment Reforms

During the COVID-19 pandemic, it is critical to remember that we are still in the midst of an overdose crisis. While many regulators have argued that methadone and buprenorphine policies must be deliberately restrictive due to the risk of overdose, adverse medication effects, and medication diversion, the COVID-19 crisis has forced many regulating bodies to re-evaluate these policies in order to comply with the urgent need for communities to practice social distancing and sheltering-in-place. Multiple government agencies including SAMHSA, the DEA, Medicare, and Medicaid have recently announced policy changes to allow for more flexible prescribing and dispensing. While these changes are a step forward, clinics have been either reluctant or resistant to fully implement them to the extent allowable under law. In light of the evolving pandemic and the needs of the community, we must not allow fears of overmedication and diversion to outweigh the health risks caused by patients being forced daily to congregate in large groups, or being driven to an adulterated illicit drug supply.

 

Close person-to-person contact and group assembly are currently actions deemed hazardous to public health. Unfortunately, “sheltering in place” is unrealistic for many people who use drugs. People who use opioids are either forced to continue to engage with the illicit drug market or must comply with prohibitive and insurmountable requirements to receive medications for Opioid Use Disorder (OUD). Many opioid users are at an increased risk of COVID-19 infection due to being immunocompromised and/or having comorbid health conditions.

 

In order to reduce the risk of COVID-19 infection, involuntary withdrawal, and drug poisoning, the Urban Survivors Union and the undersigned organizations strongly recommend the following measures be taken immediately:

 

  1. The only acceptable standard for discharge of patients from OUD treatment during the COVID-19 outbreak shall be violent behavior that would endanger their own health and safety or that of other patients or staff.

  2. Administrative detox shall be fully suspended during the pandemic and patients shall be provided the opportunity to request dose increases as needed, given that the illicit drug market will continue to experience fluctuations and patients need access to these life-saving medications. Patient doses shall not be reduced during the transition to take-home care unless they request adjustments to their doses, or documented medical emergencies require it and patients cannot consent due to medical crises, as may be the case with severe respiratory distress resulting from COVID-19 infection.

  3. Referrals for COVID-19 testing shall be made available at all opioid treatment programs (OTPs), as well as syringe service programs. Staff shall receive training to recognize the symptoms of COVID-19 and be familiarized with protocols to refer patients for further testing. Harm reduction providers can also play an essential role in “flattening the curve” of transmission by identifying cases, making medical attention available to those who test positive, and teaching life-saving harm reduction skills to help people stay safe during this crisis. Plain language and evidence-based public health materials about COVID-19 prevention, symptom identification, and treatment should be available in locally prominent languages at all locations for participants and their communities.

  4. During the COVID-19 national emergency, healthcare professionals--including doctors, nurse practitioners, physician assistants, and pharmacists--shall not be required to complete the previously- mandated training and waiver to prescribe these medications, thereby making MAT available in all settings. Prescribers shall not have limitations on the number of patients that they can treat. Naloxone and other overdose prevention tools (i.e. fentanyl test strips) shall be prescribed or made available with all dispensed medications in compliance with state law.

  5. Opioid treatment programs (OTPs), prescribing clinicians, and pharmacies shall actively work to expand access to methadone treatment through the medical maintenance/office-based and pharmacy-delivery methods currently allowed by federal exception/waiver. The existing OTP regulations for the dispensing of MAT shall be temporarily adjusted to require all pharmacies to dispense these medications. This will reduce the risks of transmission associated with daily clinic attendance and person-to-person contact. In accordance with SAMHSA recommendations, lockbox requirements for take-home dispensing shall be suspended. Standard dispensing protocols for other opioid medications are deemed sufficient, since child- and tamper-proof bottles are already in use for methadone and buprenorphine. (Per SAMHSA's TIP 43, Chapter 5: "Some programs require patients to bring a locked container to the OTP when they pick up their take-home medication to hold it while in transit. This policy should be considered carefully because most such containers are large and visible, which might serve more to advertise that a patient is carrying medication than to promote safety.")

  6. Take-home exception privileges shall be expanded to the maximum extent possible, limited only by available supply and operations for delivery. Any bottle checks that clinics wish to conduct shall be conducted by tele-medicine. Take-home schedules shall be authorized for individuals in all medical settings, including pharmacies and mobile vans. In light of new SAMHSA guidelines, clinics shall allow 14 to 28 days of take-home privileges to as many patients as possible. Patients testing positive for benzodiazepine or alcohol use shall be allowed the take-home privileges outlined in SAMHSA guidelines, but may be additionally required to check in via telemedicine for the purpose of decreasing the risk of adverse reactions, including overdose. Access to take-home doses is critical to keep patients engaged and retained in treatment.

  7. Telehealth and service by phone shall replace any and all in-person requirements and appointments as the primary means of service provision until social distancing guidelines change. Toxicology requirements shall be suspended for the duration of telehealth-based services. Telemedicine services shall include waivered platforms, such as telephone intakes and video conferencing, as some patients may have different access needs.

  8. The regulatory in-person requirements for methadone inductions shall be lifted in order to be consistent with the new policy changes for buprenorphine inductions. Clinic-based in-person appointments shall conform to social distancing requirements and OSHA guidelines for the management of the COVID-19 pandemic.

  9. DEA restrictions on mobile medication units shall be revised to accommodate delivery of medications to individuals who are sequestered in their homes, are quarantined, or live in rural communities that are 15 miles or more from the nearest opioid treatment program.

  10. State and federal Medicaid dollars shall be expanded to cover all costs for take-home medications not otherwise covered by insurance for patients experiencing financial hardship due to COVID-19. In states that did not expand Medicaid, the state shall be the payor of last resort.

 

In the interest of saving lives and adhering to existing public health protocol for management of COVID-19 transmission, it is necessary to make significant revisions to existing regulatory standards. This is a critical time to take decisive action for the protection of patients, providers, their families, and the community. As our healthcare system reaches full capacity and becomes overburdened by COVID-19-related emergencies, as seen in Italy and Spain, providers on the front lines will be forced to make life and death choices. These recommendations outline a plan of primary prevention that will minimize the burden on our healthcare system and save lives during this national emergency.

 

We, the undersigned, are a coalition of direct service providers, community advocates, public health officials, medical professionals, human rights groups, people in recovery, treatment professionals, members of impacted communities, and many others. We ask SAMHSA, the DEA, and all other federal, state, and local regulatory bodies and health authorities to adopt these recommendations fully and immediately in light of the COVID-19 pandemic.

 

 

 

Urban Survivors Union Louise Vincent, MPH Executive Director

 

National Harm Reduction Coalition

Monique Tula Executive Director

 

The National Alliance for Medication-Assisted Recovery

Zachary Talbott, MSW President

Joycelyn S. Woods, MA Executive Director

 

Faces and Voices of Recovery

Patty McCarthy, M.S. Chief Executive Officer

 

National Viral Hepatitis Roundtable

Lauren Canary, MPH Director

 

Law Enforcement Action Partnership

Major Neill Franklin (Ret.) Executive Director

 

The Levenson Foundation Benjamin A. Levenson Chairman

 

Foundation for Recovery Dona M. Dmitrovic, MHS Executive Director

 

National Council for Behavioral Health

Chuck Ingoglia President and CEO

 

Drug Policy Alliance

Kassandra Frederique

Managing Director, Policy Advocacy & Campaigns

 

International Certification & Reciprocity Consortium

Crystal Smalldon, CCAC, CIAC, RSSW President

 

Behavioral Health Association of Providers

Pete Nielsen, MA, LAADC CEO

 

Center on Addiction / Partnership for Drug- Free Kids

Frederick Muench, Ph.D. President

 

National Advocates for Pregnant Women

Lynn M. Paltrow, J.D.

Founder and Executive Director

 

Recovery Advocacy Project

Ryan Hampton Organizing Director

 

Open Society Foundations

Sarah Evans

Unit Manager, Public Health Program Kasia Malinowska-Sempruch Director, Global Drug Policy Program

 

305 Psychotherapy Group Mark Houston, LCSW Owner and Psychotherapist

 

Addiction Professionals of North Carolina

Sarah Potter, MPA Executive Director

 

AIDS United

Drew Gibson, MSW

Policy Manager for HIV & Drug User Health

 

Alcohol & Drug Abuse Certification Board of Georgia

Amanda Finley Executive Director

 

Alliance for Positive Health

Diana Aguglia Regional Director

 

The BALM Training Institute for Family Recovery Services/Family Recovery Resources Beverly A Buncher, MA, CBFRLC, PCC

Chief Executive Officer

 

Bay Area Workers Support

Maxine Holloway, MPH Co-Founder

 

Benevolence Farm

Kristen Powers

Interim Executive Director

 

Better Life in Recovery/Springfield Recovery Community Center

David Stoecker, LCSW Executive Director

 

BioMed Behavioral Healthcare, Inc Brian A McCarroll DO. MS. ABAM CEO, President

 

Brave Technology Coop

Gordon Casey

Chief Executive Officer

 

Broken No More Tamara Olt, M.D. Executive Director

 

CADA of Northwest Louisiana

Bill Rose, LAC, CCS, CCGC

Executive Director

 

C4 Recovery Foundation, Inc. Ricard Ohrstrom, Chairman Jack O'Donnell, CEO

 

Center for Optimal Living Andrew Tatarsky, Ph.D. Executive Director

 

Center for Popular Democracy/ Opioid Network

Jennifer Flynn Walker

Senior Director of Advocacy and Mobilization

 

Central Texas Harm Reduction

Richard Bradshaw Community Outreach Leader

 

CheckUpandChoices.com Reid K Hester, Ph.D. Director, Research Division

 

Chicago Drug Users Union

Peter Moinichen, CADC, CODP, MAATP Co-Founder

 

Chicago Recovery Alliance

Brandie Wilson Executive Director

 

Choices Recovery Trainings Ginger Ross, CRSW, NCPRSS Owner/Trainer

 

Church of Safe Injection

Kari Morissette Director

 

Circle for Justice Innovations Aleah Bacqui Vaughn Executive Director

 

City of Revere - Substance Use Disorder Initiatives Office

Julia Newhall, BSW, CPS Director

 

Coastal Holistic Care

Jessi Ross Founder

 

Connecticut Certification Board

Jeff Quamme, MSW Executive Director

 

DanceSafe Mitchell Gomez Executive Director

 

Desiree Alliance

Cristine Sardina, BWS, MSJ Director

 

društvo AREAL Janko Belin President

 

ekiM For Change Diannee Carden Glenn Director

 

Exponents, Inc. Joseph Turner, J.D. President and CEO

 

Faith In Public Life

Blyth Barnow, MDiv

Harm Reduction Faith Manager

 

Families for Sensible Drug Policy

Carol Katz-Beyer President

 

Florida Opiate Coalition- Block by Block

Bonny Batchelor Director

 

Foundation for Recovery Dona M. Dmitrovic, MHS Executive Director

 

Full Circle Recovery Center, LLC Stephanie Almeida, CDAC Founder

 

Georgia Overdose Prevention

Laurie Fuggitt, RN and Robin Elliott, RN Co-Founder

 

GoodWorks: North Alabama Harm Reduction

Morgan Farrington Founder

 

The Grand Rapids Red Project

Stephen Alsum Executive Director

 

Grayken Center for Addiction, Boston Medical Center

Michael Botticelli, MEd Executive Director

 

Greater Hartford Harm Reduction Coalition Inc.

Mark A. Jenkins Executive Director

 

Guilford County Solution to the Opioid Problem

Chase Holleman, LCSW, LCAS Program Director

 

Harm Reduction Action Center

Lisa Raville Executive Director

 

Harm Reduction Ohio Dennis Cauchon President

 

Harm Reduction Therapy Center

Jeannie Little, LCSW Executive Director

 

Health in Justice Action Lab Leo Beletsky, JD MPH Director

 

Health Professionals in Recovery William C. Kinkle, RN, EMT-P, CRS Co-Owner

 

Health Services Center, Inc.

Melissa Parker

Prevention Projects Director

 

Healthy Streets / Health Innovations

Mary Wheeler Program Manager

 

HIPS

Tamika Spellman

Policy and Advocacy Associate

 

HIV/HCV Resource Center Laura Byrne, MA Executive Director

 

Hope Recovery Resources

Beth Fisher Sanders, LCSW, LCAS, MAC, CCS, MATS

Chief Executive Officer

 

HRH413

Albert Park, MSW Co-Founder

 

International Network of People Who Use Drugs

Judy Chang Executive Director

 

Illinois Association of Behavioral Health

Sara Howe, MDA Executive Director

 

Inclusion Recovery Dan Ronken, LPC, LAC Founder

 

Indiana Recovery Alliance

Kass Botts Executive Director

 

Innovative Health Systems Ross Fishman, Ph.D. President

 

Instituto RIA Zara Snapp Co-Founder

 

Iowa Harm Reduction Coalition

Sarah Ziegenhorn Executive Director

 

Katal Center for Health, Equity, and Justice

Gabriel Sayegh, MPH Co-Executive Director The Lemire Group LLC Dean Lemire

Owner

 

Lifespan Counseling

Dene Berman, Ph.D., MPH, ABPP, MAC Director

 

Lysistrata Mutual Care and Collective Fund

Cora Colt

Co-Founder and Treasurer

 

MEDPEARL LLC

Deanna Dunn, PharmD Owner/Pharmacist

 

The Middle East and North African Network of/for People who use Drugs

Hasan Taraif Executive Director

 

Minnesota Recovery Connection

Wendy Jones Executive Director

 

Movement for Family Power

Lisa Sangoi and Erin Coud

Co-Founders and Co-Directors

 

NCADD- NJ

Heather Ogden, CPRS, CRSP, CADC Intern Advocacy Coordinator

 

New England Users Union

Jess Tilley Executive Director

 

New Jersey Harm Reduction Coalition

Jenna Mellor Executive Director

 

A New PATH, Parents for Addiction Treatment & Healing

Gretchen Burns Bergman Executive Director

 

New View Addiction Recovery Educational Center

Jennifer A. Burns, MA Executive Director

 

New York Center for Living

Audrey Freshman, Ph.D., LCSW, CASAC Executive Director/Chief Clinical Officer

 

New York State Harm Reduction Association

Joseph Turner, J.D. Co-Chairperson

 

North American Syringe Exchange Network/ Tacoma Needle Exchange

Paul A. LaKosky, Ph.D. Executive Director

 

North Carolina Harm Reduction Shelisa Howard-Martinez Executive Director

 

North Carolina Survivors Union

Louise Vincent, MPH Executive Director

 

Northern Berkshire EMS Stephen Murray, BBA, NRP Paramedic Supervisor

 

ONESTOP Harm Reduction Center, North Shore Health Project

Mary Doneski, MA Program Manager

 

PeerNUPS/Athens/Greece Christos Anastasiou Coordinator

 

Pennsylvania Alliance of Recovery Residences

Fred Way, MA Executive Director

 

Pennsylvania Harm Reduction Coalition

Devin Reaves, MSW Executive Director

 

People’s Action Sondra Youdelman Campaigns Director

 

The People’s Harm Reduction Alliance

Shilo Jama Executive Director

 

The Perfectly Flawed Foundation

Luke Tomsha Executive Director

 

Philadelphia Drug Users Union

David Tomlinson, BA Founder

 

Project Point Pittsburgh

Alice Bell, LCSW

Overdose Prevention Project Coordinator

 

Protect Families First Annajane Yolken Executive Director

 

Provenance Counseling

Lisa S Musarra, MSW, LCSW, LCADC, ICADV

Owner

 

The Reach Project, Inc and Reach Medical, PLLC

Justine Waldman, MD, FACEP Chief Executive Officer

 

Reframe Health and Justice

Sasanka Jinadasa Partner

 

Rights & Democracy NH, Rights & Democracy VT, Rights & Democracy Institute

Kate Logan, MA/ABD

Director of Programming & Policy

 

R Street Institute

Carrie Wade, Ph.D., MPH

Director of Harm Reduction Policy Chelsea Boyd, MS

Research Associate Harm Reduction Policy

 

San Francisco AIDS Foundation Laura Thomas, MPH, MPP Director of Harm Reduction Policy

 

The Seven Challenges LLC

Robert Schwebel, Ph.D.

Author and Program Developer

 

Sex Worker Advocacy Coaltion

Tamika Spellman Lead Organizer

 

Sex Workers Outreach Project Behind Bars

Jill McCracken, Ph.D. Co-Director

 

 

 

Sex Workers Organizing Project- USA

Christa Daring Executive Director

 

The Southern Tier AIDS Program

John Barry, LMSW Executive Director

 

Students for Sensible Drug Policy

Betty Aldrich Executive Director

 

Students For Sensible Drug Policy Africa

Ewelle Sylvester Williams, SW Vice Chairman

 

Substance Use, Policy, Education and Recovery PAC

Haley McKee Co-Chair

 

Suncoast Harm Reduction Project

Julia Negron, CAS

Founder and Lead Organizer

 

Tennessee Recovery Alliance

Sara Alese Executive Director

 

Texas Drug User Health Alliance

Mark Kinzly Executive Director

 

Texas Harm Reduction Alliance

Joy Rucker Executive Director

 

Texas Harm Reduction Conference

Emily Gray Co-Founder

 

Texas Overdose Naloxone Initiative

Mark Kinzly Executive Director

 

Truth Pharm Alexis Pleus Executive Director

 

Ukrainian Network of People who Use Drugs

Anton Basenko, ME Chair of the Board

 

University of Missouri, St. Louis Missouri Institute of Mental Health Claire Wood, Ph.D.

Rachel Winograd, Ph.D. Addiction Science Faculty

 

Urban Survivors Union, Greensboro Chapter

Derek McCray Miller Member

 

Dr. Vando Medical Services

Leonardo Vando, MD Chief Executive Officer

 

Vantage Clinical Consulting LLC Jamelia Hand, MHS, CADC, CODP Chief Executive Officer

 

Vermonters for Criminal Justice Reform Thomas Dalton, J.D., MA, LADC Executive Director

 

VICTA

Lisa Peterson, LMHC, LCDP, LCDS, MAC Chief Operating Officer

 

 

Voices of Community Activists and Leaders- New York

Jeremy Saunders Executive Director

 

Whose Corner is it Anyway

Caty Simon

Founding Co-Organizer

 

Women With A Vision

Christine Breland Lobre, MHS, MPH, LPC Program Director

 

Zanzibar Network of People Who Use Drugs

Kassim Nyuni Executive Director

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