A City Torn on a Solution

By Joseph W Kertis 05/29/20

As many know, the COVID-19 pandemic has caused the health care industry to change the way it operates drastically.  Some are not aware of the lengths to which providers are going to prevent the spread of the virus.  These extreme measures are illustrated when you examine how New York City is handling individuals who are dependent on Methadone.


Before the pandemic, individuals who used Methadone were required to visit a clinic daily to receive their medication dose. Methadone is a powerful opioid with the potential for abuse, making sense that those with a history of abusing substances are not given an abundant supply to take home.  This practice also puts those in recovery face to face with health care professionals daily, allowing for drug screening, wellness checks, and general observation on how the individual was doing. 


A recent report highlighted that over 1,000 individuals in NYC are getting their methadone medication by curbside delivery.  This practice has left a city torn.  Some are behind this movement, claiming it saves lives. But others feel it is a waste of resources during a time of crisis.


This drastic change does warrant concern. Individuals that were once getting one dose at a time under supervision now have a full week supply at their disposal with no oversight.

Furthermore, it downgrades what passes for “treatment” to a minimum. How could we possibly do less for a person struggling with a deadly mental and physical condition than give them a pill; completely ignore them? Without access to counseling, the city is ultimately giving out drugs to a demographic that is dependent on them, which is also defined as enabling by the treatment field.  These issues call into the question the system we currently have in place for handling individuals who suffer from substance abuse disorder.


The Health Commissioner for NYC, Oxliris Barbot, claims that Methadone is a life-saving medication. But this drug has is clearly addictive, if we need to resort to curbside delivery, so individuals do not go into withdrawal from not having it. Sure, we could say that it’s keeping them from using heroin, but there’s doubt it’s even accomplishing that. Methadone also has a high rate of diversion, meaning a lot of it makes it onto the streets for sale on the black market.  Often, patients sell their Methadone to get heroin, and the drug winds up being involved in a lot of overdose deaths. This topic has been a long-standing debate.


Many feel Methadone merely replaces the street or medically prescribed opiate the individual was abusing. Doing so does nothing to handle that person’s dependency on opioids. Thus, the implementation of this medication only changes someone who was abusing illicit substances into someone who is now dependent on legitimate ones. The main difference being they are receiving this drug legally from a medical professional, and it is administered in a way where abusing it is far less possible. When you do away with restrictions and give a large quantity of this medication to someone with a history of abuse, what do you have left? We’ll find out soon, as time will reveal how this strategy plays out.   


There is no right answer to this question because everyone will react differently to increased access to medication and less face-to-face interaction.  But some feel this form of treatment is “disgusting.”


Current Senator and former Manhattan prosecutor Andrew Lanza expressed that individuals who are battling substance abuse should be weaned off of dugs instead of given more.  He believes the current operating basis indicates the New York has given up on these individuals, and they are going to live the rest of their lives as addicts.


It is quite impressive.

You have two groups who want the same thing but are fighting over the right way to go about it.  Both groups claim the other’s way is hurting the group they aim to help.  This goes to show you the complexity of addiction.  The mental and behavioral nuances that make up the condition are unique, and its adverse effects on society leave everyone grasping for solutions. Regardless of your stance, the constant back and forth about which solution is best is making it harder to solve the problem.  As we remain torn, those with substance abuse disorders continue to struggle.


The drugs are already being administered, and we aren’t going to go backward in time.  At this point, it’s best to stop arguing and recognize that the school of harm reduction isn’t focused on handling addiction or treating substance abuse.  They are content with life-long dependency on opioids, so they should be allowed to pursue that since it is technically safer than using heroin.  But let’s not shut off real recovery for people who want to be ultimately drug-free. 


The latest propaganda being forwarded is that abstinence-based treatment models are “risky and negligent” because they don’t give people drugs like Methadone, putting them at unnecessary risk of relapse and overdose.  Indeed, you can’t relapse if you are still on drugs, so perhaps that’s the only valid point.  But the risk of overdose is still very high with Methadone.  So, it is no miracle cure and certainly not a replacement for actual treatment. 


Once the COVID-19 pandemic passes, we’ll have an idea of how the lowered restriction surrounding Methadone has played out in New York, and if patients are doing better or worse under the new model.  But we cannot neglect to reinforce our traditional treatment infrastructure to support the demand that will likely exist as people emerge from isolation.  People will need and want to have live interactions, counseling, and the support of others in the recovery community, not more pills. 






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