Greenwich House

Overdose deaths in the United States have more than doubled since 2015, and during the COVID-19 pandemic, Americans died of drug overdose in record numbers.

In New York City alone, 2,000 individuals died of a drug overdose in 2020, the highest number recorded since 2000. Methadone is a leading medication used to treat opioid use disorder, and when taken as prescribed, is safe and effective. The onset of the pandemic disrupted access to methadone treatment, which has historically required patients to be physically present at methadone clinics to get their daily doses. Until recently, take-home options have been strictly regulated and based on narrow eligibility criteria. During the pandemic, the federal government relaxed some restrictions on how much medication can be brought home, and additional opportunities have emerged, including the provision of monthly medication supplies coupled with counseling. During the pandemic, Greenwich House tested new approaches that use the home health workforce to help patients with telehealth. In 2022, NYHealth awarded Greenwich House a grant to pilot and evaluate a home health aide model for providing methadone maintenance and wraparound services to its eligible patients.

Under this grant, Greenwich House will identify and engage a highly targeted population of patients who are able to independently manage a monthly supply of methadone medication, if they have extra at-home supports. Recovery peer advocates will be trained and formally certified as home health aides. They will conduct biweekly visits to provide methadone maintenance to patients and be a link back to the clinic, providing updates to providers about urgent and ongoing patient needs. Home health aides will look for signs of medication non-adherence and symptoms of declining mental status; assist with daily activities; and provide support for housing stability, food security, and other basic needs. They will also set patients up for telemental health appointments. Over time, it is expected the patients will be able to self-manage their monthly supply of medication with telehealth support. Finally, Greenwich House will evaluate the model for replication and spread, partnering with an external evaluator to assess the model and focusing on clinical outcomes and cost-effectiveness. If the pilot proves successful, Greenwich House will use the results to partner with New York State Medicaid and health plans to further scale the model.