Berks County Medical Society Medical Record Summer 2020 - 17

Outpatient Methadone Treatment Programs
Outpatient methadone maintenance treatment programs
could implement many of the same changes that outpatient office
visits utilized. However, patients attending a methadone program
often have other special circumstances that need to be addressed.
Patients attending a methadone maintenance program often have a
more severe opioid use disorder. Normally a patient would have to
come to a methadone program every day until the patient earned
a take out. The individual program, within the parameters of the
state or federal rules, sets the time needed in recovery to earn a take
out. These rules, as well as rules for needed face-to-face counseling
time, were relaxed with the Covid-19 pandemic. However, just
because the rules were relaxed did not mean that every patient
was appropriate to receive the maximum number of take-outs
or the minimum hours of face-to-face counseling. Giving more
take outs and decreasing counseling to a patient who is not stable
increases the risk for diversion of medication, relapse, overdose and
death. Each methadone program needed to evaluate each patient
individually to determine what would be in the patient's best
interest.

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Inpatient Hospital Consulting Services
At every hospital across the country patients are admitted for
one medical condition only to be found to have a second or third
condition that needs to be treated in order for a successful discharge
to occur. Often a substance use disorder is identified, or known,
and needs to be addressed. In such cases tele-health is able to add a
layer of protection for both the patient and the physician. In most
cases an Addictionist completing a consult on a hospitalized patient
will not need to physically touch the patient to complete a physical
examination. Other members of the medical team will have already
listened to the patient's heart and lungs, allowing the Addictionist
to rely on a previous examination. The patient is exposed to one
less provider who may unknowingly expose the patient to the
virus and the provider is exposed to one less patient who may be
shedding the virus.
I realize that a common theme to the changes in treatment
across all scenarios of substance use disorder treatment is the use
of tele-health. While the Covid-19 pandemic pushed many of
those in authority to solve the problems and make tele-health
more accessible, secure and cost effective, there is a down side.
Choosing the wrong patient for a tele-health visit may put that
patient at risk for use, relapse, overdose and death. Tele-health
may be an excellent supplement to an office visit, but should
not be considered a complete replacement. Whether utilizing a
12-step non-medical philosophy, a medication assisted treatment
philosophy, or an appropriate combination of the two, much of the
treatment of this disease is interpersonal because often the disease
itself is caused by poor interpersonal experiences. Tele-health
cannot replace the personal and interpersonal benefits that come
with the treatment of this disease.

6/20

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SUMMER 2020

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Berks County Medical Society Medical Record Summer 2020

Table of Contents for the Digital Edition of Berks County Medical Society Medical Record Summer 2020
