COVID-19: AATOD’s Guidance for OTPs

AATOD Guidance to OTPs in Response to the Coronavirus (COVID-19) 

Maintaining Adequate Supplies of Medications and Other Vital Materials
OTPs should determine their medication management needs in order to ensure they have the proper inventory needed to treat patients effectively as more take-home medication will be required, especially if the program falls within a quarantine zone. Inventory also includes medical supplies and equipment that the programs will need to function and effectively treat patients. Please keep in mind that this is a rapidly changing event and programs need to be as prepared as possible to deal with such ongoing challenges (see CDC webpages: Steps Healthcare Facilities Can Take Now to Prepare for COVID-19 and Interim Guidance: Public Health Communicators Get Your Community Ready for Coronavirus Disease 2019 (COVID-19)). 


Facility Infectious Disease Control Standards
There are standards already in place for OTPs regarding infection control. You are advised to increase maintenance standards throughout all public access points throughout the OTP as well as all other facilities and programs under your auspices.  

This includes making sure that clean water is used when mopping floors based on typical maintenance standards, in addition to being sure that supplies e.g., soap, water and towels/proper drying equipment are available in all staff and patient bathrooms. In addition to posted handwashing protocols, there should be adequate availability of hand sanitizer throughout the facility, as well as, federal, state, and local advisories.    

The staff who manage maintenance in the facility need to be attuned to more thorough cleansing of tables, counters and all other surfaces where a virus can live. Be certain to have sufficient cleaning supplies in your inventory.  

 

Protect Your Workforce
Protect your workforce: 

  • Screen patients and visitors for symptoms of acute respiratory illness (e.g., fever, cough, difficulty breathing) before entering your healthcare facility.  Keep up to date on the recommendations for preventing spread of COVID-19 on  CDC’s website. 
  • Ensure proper use of personal protection equipment (PPE).  Healthcare personnel who come in close contact with confirmed or possible patients with COVID-19  should wear  the appropriate  personal protective equipment when at all possible. 
  • Conduct an inventory of available PPE.  Consider conducting an inventory of available PPE supplies. Explore strategies to  optimize PPE supplies. Clearly, this depends on getting additional supplies including masks and gowns. 
  • Encourage sick employees to stay home.  Personnel who develop respiratory symptoms (e.g., cough, shortness of breath) should be instructed not to report to work. Ensure that your sick leave policies are flexible and consistent with public health guidance and that employees are aware of these policies. 

 

Protect Your Patients

  • Stay up-to-date  on the best ways to  manage patients with COVID-19. 
  • Separate patients  with respiratory symptoms so they are not waiting among other patients seeking care.  Identify a separate, well-ventilated space that allows waiting patients and visitors to be separated. 
  • Consider the strategies to prevent patients who can be cared for at home from coming to your facility potentially exposing themselves or others to germs, like: 
    • Using your telephone system to deliver messages to incoming callers about when to seek medical care at your facility, when to seek emergency care, and where to go for information about caring for a person with COVID at home. 
    • Adjusting your hours of operation to include telephone triage and follow-up of patients during a community outbreak.
    • Leveraging telephone/video conferencing for counseling sessions and self-assessment tools. 

 

Staff and Patient Testing
Since our patients are already vulnerable based on pre-existing conditions, the program should consider the testing of patients or referring to a facility that offers testing, when such tests become available, especially older patient groups, pregnant women, and patients that have history of respiratory, cardiac, diabetic and other chronic illnesses.  Clearly, this is based on the availability of testing and programs should work with local health departments and health care facilities to provide needed access. 

For the purposes of maintaining the highest protection standards in OTPs, it may be prudent that staff in high risk categories consider testing since infected individuals can be completely asymptomatic.   

 

Oral and Urine Drug Screening
It is recommended that oral fluid toxicology testing be suspended.  

 

Staff Protections
Medical personnel conducting physical examinations or otherwise directly interacting with patients, should also consider additional protective gear including face masks, gloves and other appropriate protections when at all possible. This should be done in a manner that does not raise undue fear in the patients.    

 

SAMHSA/SOTA/OTP Coordination 
If patients test positive, providing take-home medication needs to be considered using the exception process when applicable.  SAMHSA and the SOTAs have taken action to accelerate rapid approval since this is a health emergency (see SAMHSA publication: “Taking Care of Your Behavioral Health- Tips for Social Distancing, Quarantine, and Isolation During an Infectious Disease Outbreak”). Blanket exemptions are now permitted by SAMHSA in states with declared emergencies and SOTAs will be submitting those requests on behalf of the OTPs in their states. In states that have not declared emergencies, SOTAs can work with OTPs to obtain blanket exemptions as needed OTPs should be communicating what is happening with their patient community with State Authorities and SAMHSA as need be so that appropriate action can be taken rapidly. SAMHSA has posted information about these issues on their website (www.samhsa.gov). 

If staff test positive, they should be sent home and self-quarantined for 14 days unless a greater intervention is medically required. 

Curbside dosing should be considered if you are concerned about a symptomatic patient coming to the clinic This should be in accordance with instruction per your SOTA.  Suggestions for curbside dosing include:   

  • The nurse can prepare the dose, put it in a locked box, and with the escort of security, dose the patient outside of the clinic area.  
  • Prepare take-home doses consistent with your clinic protocols and provide them to patients in this same way with appropriate ID verification.    
  • For patients who you deem ineligible to manage take home doses safely, consider identifying a patients family member or stable support and, with the patient’s informed consent, provide education about safe storage, chain of custody procedures, and dosing instructions for them to administer the patient’s dose.    

 

Considerations for Take-Home Medication
As is always the case, the consideration of providing take-home medication is based on individual risk/benefit assessments. Clearly, there are a number of patients in treatment who are not clinically stable, which is why so many are attending the program 6 or 7 days a week, depending on the programs operating schedule.  Programs may consider staggered dosing days (organized by alphabet, patient ID, etc.) to manage increased distribution of medication.  Consider limiting the number of patients in the waiting areas and practicing safe social distancing whenever possible.  In addition, as states and cities impose curfews, programs will need to operate in such guidance.  

Providing significant take-home medications to unstable patients should be considered very judiciously. As a reminder, we are still in the midst of a changing opioid epidemic with many opioid related overdoses each day.  If unstable patients are being given take-home medication, they should also be given access to Narcan® kits. This may be a challenge for some OTPs depending on the state or county’s regulations governing the utilization of Narcan® kits in or through an OTP 

For stable patients who are participating in the program on a onceaweek (or even less) basis, the decisions are less complex.   There are considerations around reimbursement that should be discussed with the State Opioid Treatment Authorities in addition to third-party reimbursement representatives. In this case, protecting the patients, staff and public health is the top priority.  

The most challenging situation is the provision of clinically unstable patients with take-home medication. Once again, if the program happens to be in a geographically quarantined area, it will require a blanket exception approach. As noted, this will be dealt with on a state-by-state basis per SAMHSA guidance released March 13, 2020. 

Having a quarantined geographic area clearly presents the greatest challenge which will require a program to provide patients with take-home medications.   Hospital emergency departments (ED) do not typically engage in dispensing OUD medications.   The EDs will be dealing with increasing admissions of people who are fearful of being infected and people that have been infected and need to be treated.  It is prudent to connect with your area emergency departments about their process for handling symptomatic patients, anticipated issues that they may encounter with your OTP patients, and how they may contact your OTP.     

It is not recommended that programs use blanket exceptions to provide take-home medications to unstable patients unless the OTP is in a quarantined region.  Although we do not want infected patients to come to the program and pose increased risk for the spread of this virus even further, there are liability related issues as well as risks for OTPs to be implicated in contributing to increasing opioid related overdoses.  Keep in mind that no matter what the issue, we still exist in a litigious environment.  This is why clinical personnel need to balance risk against need/benefit.  

We hope that this basic guidance will be helpful. We know that State Authorities are considering methods of dealing with this challenge and OTPs are advised to work in conjunction with the State Opioid Treatment Authorities. 

For the most up to date info on responses to COVID19 for the Treatment field go to https://www.samhsa.gov/.  For the latest information on infection control guidance for healthcare personnel and healthcare facilities go to the CDC at https://www.cdc.gov/coronavirus/2019-ncov/index.html 

 

@aatod1984
  • TREATING OPIOID USE DISORDER: SO MUCH MORE THAN MEDICATION #aatod2024

TODAY is the last day to take advantage of the discounted registration rate. #aatod2024 is the world’s premier training conference event for the treatment of #OUD.

For registration and hotel information ➡️ bit.ly/3Ue57Q6.

We look forward to seeing you in Las Vegas!
  • #aatod2024 Conference Update. Comprehensive Listing/Descriptions of Workshops, Posters, and Hot Topic Roundtable Conference Sessions are now available ➡️ http://bit.ly/3Ue57Q6.

The workshop committee is pleased to present a dynamic workshop lineup that includes extremely rich and diverse educational content for all disciplines. You will hear from experts who will share the latest research and developments relating to opioid use disorders and treatment. The workshop lineup will include state of the art information on diverse areas of focus such as patient care and best practices, building community partnerships and collaborations, public policy and regulatory changes, workforce development, quality assurance, and financial reimbursement. There will be workshops that focus on emerging treatment trends and developments such as the fentanyl epidemic, mobile opioid treatment programs, regulatory changes, expansion of treatment services in rural areas, integrating treatment with the corrections systems, and integrating harm reduction initiatives. For those newer to the field or those who want a refresher on the basics, we have once again included a “Foundations” track which will include selections on the fundamentals of medication assisted treatment.

The conference will continue to be the world’s premier training and education event for the treatment of opioid use disorders.  We hope to see you in Las Vegas!
  • Patient access to OTPs saves lives every day.

AATOD has been working with policymakers and regulatory authorities to increase access to opioid treatment programs (OTPs) though the expansion of mobile vans and Medication Assisted Treatment in correctional facilities in the United States. 

Please support AATOD's mission by making an online donation ➡️ https://bit.ly/3uDOeDC #givingtuesday
  • Lev Facher represented a fair reporting of the current #methadone policy debate that took place at last week’s #STATSummit. 

“Mark Parrino, AATOD’s founder and president, cautioned during the panel that achieving sweeping change might not be so easy. The health system, he argued, is unprepared and even unwilling to make methadone a part of primary care. Potential obstacles, he said, include doctors’ lack of enthusiasm about prescribing methadone; pharmacists’ unwillingness to stock and dispense it; and drug manufacturers’ reluctance to manufacture and distribute it more widely, especially following the lawsuits and criticism many have experienced in the wake of the opioid crisis and the prescription opioid oversupply that accelerated it.” #morethanmedicine #opioidusedisorder #OpposetheMOTAA 

Read More ➡️ bit.ly/3tKb1gy
  • Earn up to 6 LADC & LPC CEU’s at 9th Annual OKATOD Conference, which is convening this Thursday, Oct 12th in Oklahoma City. 

This year, the focus turns to the paramount theme of #harmreduction and its profound role in ushering transformative pathways to #recovery.

Registration is now officially open, and you can secure your tickets promptly ➡️ bit.ly/45l3mm1

For more information, please visit www.okatod.org or send an email to a_rios@oktreatment.com.
  • Join OKATOD, one of AATOD’s state chapters, in Oklahoma City on Oct 12 as they convene their ninth annual OKATOD Conference. This year’s theme is HARM REDUCTION: A TRANSFORMATIVE APPROACH. 

Speakers include Mark Parrino (AATOD President), Maia Szalavitz, Teresa Stephensen, Dr. Larry Lovelace, Angela Harnden, Shajine Blake, and Jason Hall. 

Register ➡️ bit.ly/461CkkG
  • Final Opportunity to Submit Proposals for the #aatod2024 Conference. The submission window will close tonight at 12am ET.

To submit a proposal, please follow the on-screen instructions, bit.ly/3KxQSzU. For questions or additional information regarding the Call for Presentations, please send an email to meetings@aatod.org or call 856-423-3091.

We look forward to receiving your submissions and hope to see you at the conference for what will be the premier conference on the treatment of opioid use disorders in 2024! #morethanmedicine #programnotapill #opioids #OUD #OpioidUseDisorder #submitproposal
  • Today is the Final Day to Submit Proposals for the #aatod2024 conference, 9/21 ➡️ bit.ly/3KxQSzU

The Workshop Committee encourages you to submit proposals on innovative initiatives to enhance patient outcomes, improve program development and administration, promote integration across the continuum of care, and the development of collaborations with organizations outside of the traditional opioid treatment system.

Conference Objectives:
1️⃣Conduct a comprehensive review of the latest evidence addressing the opioid epidemic and its implications for patients, clinicians, administrators, and policy makers by identifying the most effective interventions.
2️⃣Discuss peer to peer approaches in treating opioid use disorder in an effort to improve patient outcomes in health systems, organizations, and communities.
3️⃣Evaluate the gaps in current services for opioid use disorder and develop recommendations to improve the delivery of multidisciplinary care in various populations based upon evidence-based practices.
4️⃣Disseminate a comprehensive plan of innovative services designed to treat emerging needs of patients with opioid use disorder and improve patient outcomes by providing examples of effective methods and how to implement them.
5️⃣Identify effective referral pathways to other health services offering treatment for conditions associated with opioid use disorder addiction and/or recovery by developing partnerships within the community.
  • We are pleased to announce that the deadline for submitting presentations for the #aatod2024 Conference has been extended to Thursday, September 21, 2023.

We encourage all interested parties to take advantage of this opportunity and submit their proposals as soon as possible. We look forward to receiving your proposals and to seeing you in Las Vegas in 2024. 

https://conta.cc/3PiV5ck
  • August 31st is International Overdose Awareness Day 
💜 #IOAD2023 
💜 #NaloxoneSavesLives 
💜 #EndOverdoseNow

Please contact your State Opioid Treatment Authority for locations in your community that distribute naloxone kits —> bit.ly/3qVPOPz. 

 Full Video 🎥 bit.ly/3ElzdYD
TREATING OPIOID USE DISORDER: SO MUCH MORE THAN MEDICATION #aatod2024

TODAY is the last day to take advantage of the discounted registration rate. #aatod2024 is the world’s premier training conference event for the treatment of #OUD.

For registration and hotel information ➡️ bit.ly/3Ue57Q6.

We look forward to seeing you in Las Vegas!
TREATING OPIOID USE DISORDER: SO MUCH MORE THAN MEDICATION #aatod2024 TODAY is the last day to take advantage of the discounted registration rate. #aatod2024 is the world’s premier training conference event for the treatment of #OUD. For registration and hotel information ➡️ bit.ly/3Ue57Q6. We look forward to seeing you in Las Vegas!
3 weeks ago
View on Instagram |
1/10
#aatod2024 Conference Update. Comprehensive Listing/Descriptions of Workshops, Posters, and Hot Topic Roundtable Conference Sessions are now available ➡️ http://bit.ly/3Ue57Q6.

The workshop committee is pleased to present a dynamic workshop lineup that includes extremely rich and diverse educational content for all disciplines. You will hear from experts who will share the latest research and developments relating to opioid use disorders and treatment. The workshop lineup will include state of the art information on diverse areas of focus such as patient care and best practices, building community partnerships and collaborations, public policy and regulatory changes, workforce development, quality assurance, and financial reimbursement. There will be workshops that focus on emerging treatment trends and developments such as the fentanyl epidemic, mobile opioid treatment programs, regulatory changes, expansion of treatment services in rural areas, integrating treatment with the corrections systems, and integrating harm reduction initiatives. For those newer to the field or those who want a refresher on the basics, we have once again included a “Foundations” track which will include selections on the fundamentals of medication assisted treatment.

The conference will continue to be the world’s premier training and education event for the treatment of opioid use disorders.  We hope to see you in Las Vegas!
#aatod2024 Conference Update. Comprehensive Listing/Descriptions of Workshops, Posters, and Hot Topic Roundtable Conference Sessions are now available ➡️ http://bit.ly/3Ue57Q6. The workshop committee is pleased to present a dynamic workshop lineup that includes extremely rich and diverse educational content for all disciplines. You will hear from experts who will share the latest research and developments relating to opioid use disorders and treatment. The workshop lineup will include state of the art information on diverse areas of focus such as patient care and best practices, building community partnerships and collaborations, public policy and regulatory changes, workforce development, quality assurance, and financial reimbursement. There will be workshops that focus on emerging treatment trends and developments such as the fentanyl epidemic, mobile opioid treatment programs, regulatory changes, expansion of treatment services in rural areas, integrating treatment with the corrections systems, and integrating harm reduction initiatives. For those newer to the field or those who want a refresher on the basics, we have once again included a “Foundations” track which will include selections on the fundamentals of medication assisted treatment. The conference will continue to be the world’s premier training and education event for the treatment of opioid use disorders. We hope to see you in Las Vegas!
4 weeks ago
View on Instagram |
2/10
Patient access to OTPs saves lives every day.

AATOD has been working with policymakers and regulatory authorities to increase access to opioid treatment programs (OTPs) though the expansion of mobile vans and Medication Assisted Treatment in correctional facilities in the United States. 

Please support AATOD's mission by making an online donation ➡️ https://bit.ly/3uDOeDC #givingtuesday
Patient access to OTPs saves lives every day. AATOD has been working with policymakers and regulatory authorities to increase access to opioid treatment programs (OTPs) though the expansion of mobile vans and Medication Assisted Treatment in correctional facilities in the United States. Please support AATOD's mission by making an online donation ➡️ https://bit.ly/3uDOeDC #givingtuesday
3 months ago
View on Instagram |
3/10
Lev Facher represented a fair reporting of the current #methadone policy debate that took place at last week’s #STATSummit. 

“Mark Parrino, AATOD’s founder and president, cautioned during the panel that achieving sweeping change might not be so easy. The health system, he argued, is unprepared and even unwilling to make methadone a part of primary care. Potential obstacles, he said, include doctors’ lack of enthusiasm about prescribing methadone; pharmacists’ unwillingness to stock and dispense it; and drug manufacturers’ reluctance to manufacture and distribute it more widely, especially following the lawsuits and criticism many have experienced in the wake of the opioid crisis and the prescription opioid oversupply that accelerated it.” #morethanmedicine #opioidusedisorder #OpposetheMOTAA 

Read More ➡️ bit.ly/3tKb1gy
Lev Facher represented a fair reporting of the current #methadone policy debate that took place at last week’s #STATSummit. “Mark Parrino, AATOD’s founder and president, cautioned during the panel that achieving sweeping change might not be so easy. The health system, he argued, is unprepared and even unwilling to make methadone a part of primary care. Potential obstacles, he said, include doctors’ lack of enthusiasm about prescribing methadone; pharmacists’ unwillingness to stock and dispense it; and drug manufacturers’ reluctance to manufacture and distribute it more widely, especially following the lawsuits and criticism many have experienced in the wake of the opioid crisis and the prescription opioid oversupply that accelerated it.” #morethanmedicine #opioidusedisorder #OpposetheMOTAA Read More ➡️ bit.ly/3tKb1gy
4 months ago
View on Instagram |
4/10
Earn up to 6 LADC & LPC CEU’s at 9th Annual OKATOD Conference, which is convening this Thursday, Oct 12th in Oklahoma City. 

This year, the focus turns to the paramount theme of #harmreduction and its profound role in ushering transformative pathways to #recovery.

Registration is now officially open, and you can secure your tickets promptly ➡️ bit.ly/45l3mm1

For more information, please visit www.okatod.org or send an email to a_rios@oktreatment.com.
Earn up to 6 LADC & LPC CEU’s at 9th Annual OKATOD Conference, which is convening this Thursday, Oct 12th in Oklahoma City. 

This year, the focus turns to the paramount theme of #harmreduction and its profound role in ushering transformative pathways to #recovery.

Registration is now officially open, and you can secure your tickets promptly ➡️ bit.ly/45l3mm1

For more information, please visit www.okatod.org or send an email to a_rios@oktreatment.com.
Earn up to 6 LADC & LPC CEU’s at 9th Annual OKATOD Conference, which is convening this Thursday, Oct 12th in Oklahoma City. This year, the focus turns to the paramount theme of #harmreduction and its profound role in ushering transformative pathways to #recovery. Registration is now officially open, and you can secure your tickets promptly ➡️ bit.ly/45l3mm1 For more information, please visit www.okatod.org or send an email to a_rios@oktreatment.com.
4 months ago
View on Instagram |
5/10
Join OKATOD, one of AATOD’s state chapters, in Oklahoma City on Oct 12 as they convene their ninth annual OKATOD Conference. This year’s theme is HARM REDUCTION: A TRANSFORMATIVE APPROACH. 

Speakers include Mark Parrino (AATOD President), Maia Szalavitz, Teresa Stephensen, Dr. Larry Lovelace, Angela Harnden, Shajine Blake, and Jason Hall. 

Register ➡️ bit.ly/461CkkG
Join OKATOD, one of AATOD’s state chapters, in Oklahoma City on Oct 12 as they convene their ninth annual OKATOD Conference. This year’s theme is HARM REDUCTION: A TRANSFORMATIVE APPROACH. Speakers include Mark Parrino (AATOD President), Maia Szalavitz, Teresa Stephensen, Dr. Larry Lovelace, Angela Harnden, Shajine Blake, and Jason Hall. Register ➡️ bit.ly/461CkkG
5 months ago
View on Instagram |
6/10
Final Opportunity to Submit Proposals for the #aatod2024 Conference. The submission window will close tonight at 12am ET. To submit a proposal, please follow the on-screen instructions, bit.ly/3KxQSzU. For questions or additional information regarding the Call for Presentations, please send an email to meetings@aatod.org or call 856-423-3091. We look forward to receiving your submissions and hope to see you at the conference for what will be the premier conference on the treatment of opioid use disorders in 2024! #morethanmedicine #programnotapill #opioids #OUD #OpioidUseDisorder #submitproposal
5 months ago
View on Instagram |
7/10
Today is the Final Day to Submit Proposals for the #aatod2024 conference, 9/21 ➡️ bit.ly/3KxQSzU The Workshop Committee encourages you to submit proposals on innovative initiatives to enhance patient outcomes, improve program development and administration, promote integration across the continuum of care, and the development of collaborations with organizations outside of the traditional opioid treatment system. Conference Objectives: 1️⃣Conduct a comprehensive review of the latest evidence addressing the opioid epidemic and its implications for patients, clinicians, administrators, and policy makers by identifying the most effective interventions. 2️⃣Discuss peer to peer approaches in treating opioid use disorder in an effort to improve patient outcomes in health systems, organizations, and communities. 3️⃣Evaluate the gaps in current services for opioid use disorder and develop recommendations to improve the delivery of multidisciplinary care in various populations based upon evidence-based practices. 4️⃣Disseminate a comprehensive plan of innovative services designed to treat emerging needs of patients with opioid use disorder and improve patient outcomes by providing examples of effective methods and how to implement them. 5️⃣Identify effective referral pathways to other health services offering treatment for conditions associated with opioid use disorder addiction and/or recovery by developing partnerships within the community.
5 months ago
View on Instagram |
8/10
We are pleased to announce that the deadline for submitting presentations for the #aatod2024 Conference has been extended to Thursday, September 21, 2023. We encourage all interested parties to take advantage of this opportunity and submit their proposals as soon as possible. We look forward to receiving your proposals and to seeing you in Las Vegas in 2024. https://conta.cc/3PiV5ck
5 months ago
View on Instagram |
9/10
August 31st is International Overdose Awareness Day 💜 #IOAD2023 💜 #NaloxoneSavesLives 💜 #EndOverdoseNow Please contact your State Opioid Treatment Authority for locations in your community that distribute naloxone kits —> bit.ly/3qVPOPz. Full Video 🎥 bit.ly/3ElzdYD
6 months ago
View on Instagram |
10/10

Announcing groundbreaking updates: HHS/SAMHSA's new regulations mark a significant step forward for opioid treatment programs. Fostering enhanced accessibility, flexibility and patient dignity. Gratitude to @@AATOD1984 for their pivotal role in this progress. #OpioidTreatment

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2024 Conference

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