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Last week, Mayor Bill de Blasio quietly began an unprecedented and unusual effort to help stem the spread of COVID-19: door-to-door delivery of methadone to homeless shelter residents and discharged hospital patients placed in so-called isolation hotels.

On Monday, the city health department plans to expand this never-before-done delivery of the synthetic opioid to homes of COVID-19-positive narcotics users who need the drug to wean themselves off heroin.

It marks a new distribution approach for methadone — deemed a controlled substance by the federal Drug Enforcement Administration and tightly regulated.

“People who have COVID, COVID-like symptoms or factors that put them at high risk can’t easily or safely get their methadone in person from a clinic,” said Stephanie Buhle, a health department spokesperson. “So we’re grateful the federal government is allowing us to deliver methadone to some patients.”

An elderly man was dropped off at a Jamaica, Queens, hotel shelter, April 2, 2020. Credit: Ben Fractenberg/THE CITY

Under normal circumstances, home delivery is strictly prohibited and users are required to obtain methadone in person, at clinics. And under federal regulations, people have to show up for each dose daily.

COVID-19 made that protocol dangerous, particularly for narcotics users who have tested positive for coronavirus, and are forced to leave their shelter-in-place domiciles and venture out into public to obtain their daily supply.

So on March 16, as the flood of new COVID-19 hospitalizations reached its peak in New York City, the U.S. Department of Health & Human Services waived the rule and allowed patients to pick up supplies of up to 28 days at once.

The city Department of Health and Mental Hygiene (DOHMH), teaming with the state Office of Addiction Services and Supports, worked out a system to bring supplies to patients via city vans.

On April 20, the city health workers began delivering two-week and four-week doses to patients staying in the isolation hotels. Now they plan to start home delivery.

‘Horrific Choice’

Jasmine Budnella, drug policy coordinator for the non-profit VOCAL-NY, said methadone needs have proved acute at isolation hotels booked by the city where COVID-positive and -exposed homeless shelter residents and discharged hospital patients have been placed in recent weeks to help contain the spread of the virus.

The hotel residents face a tough decision: go out in public to obtain their usual dose of methadone and possibly infect others — or miss their treatment and face the likelihood of painful withdrawal.

“People weighed this horrific choice of disrupting their treatment plans which could mean withdrawal or being sick, or not feeling well and having to navigate the city to get your lifesaving treatment,” Budnella said. “It was impossible.”

She recounted the saga of a COVID-19-positive client who needed a re-supply before the delivery system was in place. The client, who had been placed in an isolation hotel in Brooklyn, tried to arrange to have methadone set aside at the clinic he regularly visited before the pandemic struck.

He needed to complete a bureaucratic obstacle course, starting with getting a nurse assigned to the hotel to reach out to the Department of Homeless Services to deal with the clinic.

Getting in touch with the nurse was not easy because she would only contact him by his cell phone — his room had no phone — and the connection at the hotel was terrible, Budnella said. Ultimately, the pickup was arranged — he traveled to and from the Manhattan clinic via subway.

She said he ran out before the delivery program kicked in and left the hotel about 10 days ago. He hasn’t been heard from since and is believed to be living on the streets.

The arrival of the city’s new delivery system, Budnella said, will save lives.

“The fact that New York City has finally launched a delivery service for people in isolation is groundbreaking and a huge lift for people to receive their lifesaving treatment,” she said.

Security Precautions

There are myriad logistical issues with this new approach, starting with the ability to keep the methadone supply at the hotels in a secure spot.

Buhle said that each patient will get their own lockbox and key “to prevent other people from accessing the medication.”

And since it is possible to overdose on methadone, it’s crucial that the dosage regimen be monitored by medical staff on site. City health staff will also be delivering supplies of naloxone, the anti-overdose drug.

DHS officials have said they have clinicians at all five of the hotels they’re using, though tenants have told THE CITY that coverage is spotty. And at least one shelter virus-infected resident DHS deemed had “mild” symptoms died while staying at a hotel.

Until recently, the Office of Emergency Management was relying on nurses to make phone “wellness checks” without actually being on site. That changed after three men died at a hotel in Times Square last weekend and Mayor Bill de Blasio ordered medical oversight to be improved at all isolation hotels.

Patients receiving methadone deliveries have already been approved to manage their own medical regimens. Clinical staff from the patients’ treatment programs will call to check on them and monitor the continuance of their supply, city officials said.

On Friday, health officials couldn’t quantify how many residents will receive door-to-door methadone deliveries, noting the numbers will fluctuate “depending on who has COVID-like illness.”

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