Amanda Marr has been a client at the Discovery House methadone clinic in Waterville for seven years. She said she’s never missed her dose or failed a urine test.
Marr figured she’d be the perfect candidate to take advantage of recently relaxed federal restrictions put in place because of the coronarvirus outbreak. Patients, as many as 4,000 in Maine, who are accustomed to making regular visits to the clinic to get their medication can now get take-home doses of up to one month.
But that hasn’t happened for everyone. Because decisions are left to individual providers, many patients must still visit their clinic regularly.
Marr, 37, who lives in Belgrade, already had been getting a week’s worth of take-home doses before the outbreak and said nothing has changed. She said she knows other clients who still have to visit once a day or every other day.
And, she said, they are still requiring group therapy sessions.
“I told them I wasn’t going to group,” Marr said. “I’m not going to sit in a room full of people who might be sick.”
Two weeks ago, the U.S. Substance Abuse and Mental Health Services Administration released new guidelines for methadone clinics and patients, allowing for up to four weeks of take-home doses for stable patients, without any state or federal sign off required. Less stable patients could get up to two weeks of medication.
That’s a major shift for methadone, which has always been far more restrictive that the other main type of medication treatment for opioid use disorder, suboxone, sometimes called buprenorphine.
Methadone can be dispensed only at federally licensed clinics, not through doctor’s offices or pharmacies. It is often administered in higher doses than suboxone, which means there is more risk of overdose.
But as some patients are finding out, discretion still lies with the doctors at each clinic.
AnnMarie, a methadone client who asked that her last name not be published because she fears her treatment might be affected, said she still has to go every other day.
“My counselor said it would be irresponsible to get four weeks’ worth,” she said. “But I feel like I’m putting myself in jeopardy every time I go there. Just because we’re addicts … I mean, we eat too. I’ve gone into convenience stores that have better protections.”
A receptionist at the Waterville clinic said media calls must go through the Discovery House corporate office in Tennessee. No one there returned messages left by the Press Herald.
Discovery House operates four of Maine’s 10 methadone clinics – in Waterville, South Portland, Bangor and Calais. There are two additional clinics in Bangor, along with one each in Rockland, Westbrook, Portland and Lewiston.
Jim Cohen, an attorney with Verrill Dana who represents most of Maine’s methadone clinics, including those run by Discovery House, said all are aware of the challenges right now to create a safe environment for patients and employees.
“Clinics that are part of our coalition have been actively working for ways to efficiently allow for more take home doses consistent with federal guidelines,” he said. “But there still needs to be case-by-case evaluation.”
Maine Department of Health and Human Services spokeswoman Jackie Farwell said Friday her agency has received two constituent complaints since the new federal guidelines on methadone were put in place. In each case, DHHS found that the methadone provider followed the recommended guidelines.
“DHHS is in daily communication with opioid treatment programs and requires them to contact patients receiving take-home doses at least weekly through virtual visits,” she said in an email. “This is part of our broader work to promote the expansion of telehealth, including through MaineCare. Additionally, DHHS has facilitated distribution of naloxone to the opioid treatment programs for them to provide with take-home doses due to the potential for overdose.”
Gov. Janet Mills’s administration “will continue to take steps to ensure that Maine people affected by substance use disorder have access to medication, treatment and support,” Farwell said.
Frances Millhollan, 48, of Brunswick receives methadone at CAP Quality Care in Westbrook but said she has not been offered long-term doses. Even if she were considered less stable, the new federal guidelines suggest she could get up to two weeks’ worth of medicine.
“They are still making me go every day,” she said.
Millhollan was first prescribed methadone two and a half years ago. She said she can’t just switch to suboxone, because that would require her to completely taper off methadone and risk sickness, withdrawal and possible relapse.
“I’m risking my life every day for a drug that is considered essential,” she said. “They wouldn’t do this for someone with diabetes. I’m appalled.”
Courtney Jacek, program director for CAP Quality Care, said although the federal government eased restrictions, the clinic treats each client individually.
“There are still safety concerns, particularly if someone is deemed at risk of having a large supply at home,” she said.
Jacek said most clients were “pretty understanding.” She declined to answer additional questions.
Maine is in a prolonged opioid crisis that has resulted in more than 1,700 overdose deaths in the past five years and has led many to seek medication-assisted treatment, which is considered the best way to treat opioid use disorder.
Some 7,182 people were prescribed suboxone in the year ending June 30, 2019, according to the most recent data from the Maine Health Data Organization. There are about 4,000 methadone clients in Maine, Cohen said.
Suboxone providers in Maine have largely switched from in-person appointments to telephone sessions, which means their medication is not at risk of disruption. Some patients also have gotten longer prescriptions in light of the restrictions from coronavirus.
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