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 to add your/agency's signature.

For the Media 

Contact Adam Handelsman

(512) 363-0594

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 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



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



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



Lifespan Counseling

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


Lysistrata Mutual Care and Collective Fund

Cora Colt

Co-Founder and Treasurer



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



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




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



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