Mount Sinai West is seeking state approval to end its methadone program in late 2023, according to plans filed with the New York Department of Health (DOH).
Executives at the 514-bed hospital, which is located in Manhattan’s Upper West Side, applied in late June to decertify and close its methadone maintenance outpatient treatment program. The closure will affect 300 patients, 25% of whom are receiving buprenorphine treatment, Mount Sinai spokesperson Lucia Lee told Healthcare Brew.
“This site is the smallest of the six Mount Sinai opioid treatment programs (OTPs) in Manhattan and Brooklyn, and has a robust buprenorphine treatment track,” Lee said. “All existing patients will be offered a choice of where to transfer their care, and we will carefully coordinate handoff with new treatment providers. Moreover, all of our patients on buprenorphine will be able to continue to get treatment, if they choose, at one of our outpatient programs.”
DOH spokesperson Monica Pomeroy said “the department is currently reviewing Mount Sinai West’s application.”
Mount Sinai executives noted in their application that the request comes amid “significant changes” in recent years as to how methadone is used to treat substance use and opioid use disorders. Lee added that the expansion of the system’s buprenorphine-based treatment is “a high priority.”
Many patients have transitioned to buprenorphine, “reducing the need for methadone treatment services,” the hospital said. Further, the space used for the outpatient OTP would be part of a planned expansion of Mount Sinai West’s emergency department and comprehensive psychiatric emergency program.
“One of the greatest challenges in access to opioid treatment is not just about having enough treatment programs; rather, it is the often long and complicated process of engaging and motivating individuals with opioid use disorder into treatment,” Lee said.
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Buprenorphine has become an increasingly popular replacement for methadone due to “claims of less abuse potential and lower overdose risk,” according to 2012 research from North West London NHS Foundation Trust.
A 2023 article published in the Lancet found some instances in which buprenorphine “reduced cocaine use, cravings, anxiety, and cardiac dysfunction, as well as increased treatment satisfaction among people receiving [the treatment] compared with methadone.” The researchers also found evidence of “reduced hospitalization and alcohol use in people receiving methadone.”
Prescribing flexibilities enacted in response to the Covid-19 pandemic made it easier for people with substance use disorder to access buprenorphine via telemedicine. Those flexibilities were temporarily extended this spring.
Public health experts have noted that the recent increase in opioid use disorder and overdoses coincided with the Covid-19 pandemic, but research showing how much the pandemic directly contributed to the trend remains inconclusive.
In New York City, the overall overdose rate increased to 39.4 deaths per 100,000 residents in 2021, compared with 31.6 deaths per 100,000 people in 2020, according to the latest data from the city health department. The majority of these deaths involve an opioid.
Black people who use drugs—who nationally are more likely to receive a shorter duration of buprenorphine treatment than their white counterparts—also die at higher rates in New York City.
The city health department reported that 43.6 opioid-involved overdose deaths occurred per 100,000 Black New York residents, compared with 31.8 deaths per 100,000 white New York residents in 2021.