Facing ‘a real tough choice’
Baltimore’s addicts being sent home with more methadone than ever
More addiction-treatment medicine is being sent home with heroin addicts than ever before after state and federal regulators eased restrictions amid the deadly coronavirus outbreak.
Authorities had limited take-home medicine to ensure it isn’t abused or sold on the streets. But providers say the change is necessary in this time of social distancing to thin the crowds that typically fill treatment centers.
The Rev. Milton Emanuel Williams Jr. usually dispenses a daily dose of methadone or Suboxone from his East Baltimore clinic to each of his clients. Now, he’s sending addicts home with a pill bottle to last as long as 28 days.
“We’re putting a lot of methadone and Suboxone on the street right now, which is a huge concern to me,” said Williams, who runs Turning Point Clinic, the biggest treatment center in Baltimore. “There are folks who can’t handle all this medication.”
Williams and other treatment providers say they feel compelled to give out larger quantities of take-home medicine to reduce visits and protect patients and staff. Federal regulators issued new directives last month allowing the takehome doses to limit the person-toperson interactions that spread the virus.
In normal times, Turning Point Clinic may treat more than 2,000 people in a day, Williams said. Now his staff wears gloves and masks to dispense methadone or Suboxone.
“It’s almost impossible, in giving compassionate care, to not get close to
people,” he said.
Treatment providers are bracing for a possible outbreak at Baltimore’s clinics and among vulnerable communities of recovering drug addicts. Most of these people are between 45 and 55 years old and suffer chronic health problems, providers say.
The virus has infected more than 8,200 people across Maryland and killed more than 200 of them, according to state figures. In addition, cases of COVID-19 have been reported at more than 90 nursing homes in Maryland. With the virus running rampant in Maryland, those who treat drug addiction in Baltimore are making difficult decisions to scale down services and protect their workers.
In East Baltimore, the nonprofit Charm City Care Connection reduced hours at its drop-in center, a site for clean needles. The Baltimore City Health Department also slashed hours of its needle-exchange program.
“People are having a much harder time getting clean syringes,” said Natanya Robinowitz, director of Charm City Care Connection. “People are just having to reuse multiple times or they’re having to share needles.”
Robinowitz worries these conditions could lead to an outbreak of Hepatitis C or HIV.
Researchers have estimated 20,000 people in Baltimore are addicted to opioids, and the coronavirus has done little to disrupt the supply of heroin on the streets. A police commander and Drug Enforcement Administration spokesman both say the drug trade hasn’t slowed.
Col. Richard Worley, the city’s chief of patrol, said drug dealers are even seen wearing protective face masks and gloves.
Some drug treatment providers, however, notice signs the market may be changing. One heroin pill used to cost about $6 on the streets, said Dr. Yngvild Olsen, medical director for the Institutes for Behavior Resources Inc., which runs an addiction treatment center in Old Goucher.
“I had a patient last week tell me that heroin now is $2 to $3 a pill,” she said. “One of the big questions is, what is happening with the drug supply?”
Olsen said patients have told her the heroin is not just cheaper, but poorer quality and dirtier. In addition, the synthetic drug fentanyl — cheaper and more potent than heroin — had outpaced heroin on the streets, she said.
Before the outbreak, as many as 120 people visited her clinic in a day. Her patients were crushed when staff made the difficult decision to stop group sessions and try counseling by phone, another step toward social distancing.
“There has been significant concern that opioid treatment programs really could become hot spots for coronavirus,” Olsen said.
On March 16, federal regulators handed down new guidelines to states allowing clinics to send recovering addicts home with enough medicine to last them 14 or 28 days. Maryland officials are following the guidance, a state spokesman said.
Previously, clinics gave out daily doses to new patients. Or patients had to spend long periods of time in treatment to qualify for take-home medicine.
“Programs across the city are really weighing: How do we balance the risk of COVID-19 transmission within our patient population?” Olsen said, “and also balancing the risk of having more medication, like methadone, out in the community.”
Methadone is dangerous for people without the tolerance of an opioid addiction; it could cause an overdose. The medicine also becomes dangerous if an addict is drinking alcohol or taking another prescription, say, Xanax. Methadone and Suboxone are smuggled into prisons and bought and sold on the streets. A 28-day supply could fetch as much as $2,000, said Williams, of Turning Point Clinic.
“There’s probably 10 times more addicts not in treatment,” he said. “That’s why the demand for the medication is so high.”
Some patients are selling their medicine or being robbed of it, Williams said, only to come back for more. Staff give such patients smaller doses more frequently, but person-to-person exchanges put everyone at risk.
“It become a tough choice, a real tough choice,” Williams said.
“We’re putting a lot of methadone and Suboxone on the street right now, which is a huge concern to me.”
Milton Emanuel Williams Jr.