In late May, Melissa Weimer, DO, MCR, and Anne Dowton, MD, dispensed the first three-day take home supply of methadone to treat opioid use disorder on the Yale Addiction Medicine Consult Service (YAMCS) at Yale New Haven Hospital (YNHH).
The U.S. Department of Justice Drug Enforcement Administration (DEA) now allows health professionals the ability to dispense a three-day supply of narcotic medication to individuals who are experiencing acute withdrawal symptoms.
The new exception to the Code of Federal Regulations 21 CFR 1306.07(b) went into effect in March of 2022, and was implemented by Yale New Haven Hospital early last month.
Prior to this new exception, the DEA had a 72-hour rule that allows for non-opioid treatment programs, such as a clinic or hospital, to dispense a daily dose of narcotics to a patient outside of a treatment program, but it was highly regulated and required patients to return daily to receive medication treatment.
“While it’s always been an option, most providers can’t and don’t use it because it’s time consuming and there are so many regulatory barriers. It’s also hard for the patients because they need to come back daily to the hospital or emergency department to get the medication,” said Weimer, medical director of YAMCS, associate professor of medicine (general medicine) at Yale School of Medicine (YSM) and of epidemiology (chronic diseases) at Yale School of Public Health (YSPH).
The process of implementing the new protocol at YNHH was involved. Several teams throughout the hospital, including the legal department and pharmacy, had to solidify the process.
With the new exception, a practitioner must register under their individual DEA license number. Once their request is reviewed and approved, the prescriber is then able to dispense the life-saving medication to patients. The exception is valid for up to one year after issuance.
Any time you have a disruption or interruption of care, individuals are at very high risk of returning to drug or opioid use, and then subsequent risk for overdose death. And we know that the longer you stay on medication treatment–if you have an opioid use disorder–the better your outcomes are.
Melissa Weimer, DO, MCR, medical director of Yale Addiction Medicine Consult Service (YAMCS).
The first patient to receive the take home treatment was an individual who was leaving for a skilled nursing facility on a Friday of a holiday weekend. Since opioid treatment programs are not typically open on Saturdays, the patient would have had to otherwise stay in the hospital until Tuesday.
“This patient would have stayed in the hospital for the long weekend to get methadone, or gone to the skilled nursing facility and not received the methadone for three days,” said Weimer. “Any time you have a disruption or interruption of care, individuals are at very high risk of returning to drug or opioid use, and then subsequent risk for overdose death. And we know that the longer you stay on medication treatment–if you have an opioid use disorder–the better your outcomes are.”
Ability to provide take-home methadone allowed the team to facilitate the patient’s discharge, keep them on methadone, and connect them to an opioid treatment program for that following Tuesday.
“If it had not been for the provision and ability to dispense the medication, it would have prolonged the patient’s hospital stay. There was also a chance that if beds were needed, they would have been discharged to an unsafe situation,” adds Weimer.
Not only does this have a positive impact on those with opioid use disorder (OUD), but hospital systems as well. Patients can continue to receive addiction treatment without interruptions and hospitals can facilitate more seamless, patient-centered discharge planning, thereby freeing beds up for others.
Dowton, clinical fellow in the Yale Program in Addiction Medicine, was involved in treating the patient, dispensing the medication, and was surprised how seamless the process was.
“It was incredible to see how helpful this provision was in facilitating smooth coordination and transfer of care. Our patient was incredibly grateful and relieved to be continuing treatment and taking the medication that has helped them stay well and stable. The thought of going without it was intimidating and overwhelming” remarks Dowton.
It was incredible to see how helpful this provision was in facilitating smooth coordination and transfer of care. Our patient was incredibly grateful and relieved to be continuing treatment and taking the medication that has helped them stay well and stable. The thought of going without it was intimidating and overwhelming.
Anne Dowton, MD, clinical fellow in the Yale Program in Addiction Medicine.
Opioid use disorder carries a risk for opioid withdrawal, a condition that, if left untreated, can lead individuals to return to unsafe opioid use. Methadone and buprenorphine are treatments of opioid use disorder and opioid withdrawal and are utilized by YAMCS at YNHH. These medications are highly effective to protect against opioid overdose and significantly reduce mortality risk. These medications are the gold standard for treatment of opioid use disorder.
Dowton finishes her fellowship at the end of June, but is taking this experience with her.
“This is a perfect example of one of the many things I’ve learned from working with Dr. Weimer and the other attendings on the addiction consult service. With patience, time, and hard work, these systemic barriers to care for our patient population can be broken down. There are solutions to help people–in tangible and meaningful ways–that are not only going to benefit the patient, but healthcare systems.”
If you or a loved one are seeking treatment resources for substance use and addiction, please contact your primary care provider to discuss options available or visit findtreatment.gov to locate services in your area.
The Yale Program in Addiction Medicine works to expand access to and improve effectiveness of diagnosis, prevention, treatment, and harm reduction services for substance use. Our efforts span clinical practice, research, education, and policy. We provide evidence-based clinical care, conduct rigorous and innovative research, train the next generation of addiction specialists, and engage in policy and advocacy initiatives at the local, state, and national levels. Learn more about how you can support this and other practice-changing work.