SF clinic eagerly awaits expanded methadone access

California regulations around methadone, an opioid-addiction treatment that experts consider a lifesaving medication, are now in line with federal guidelines.

Gov. Gavin Newsom signed into law Assembly Bill 2115 on Friday, a measure introduced by San Francisco Assemblymember Matt Haney earlier this year. Patients treated for opioid addiction can now take home up to 72 hours worth of methadone doses, and doctors outside of specifically certified methadone programs can distribute the medication.

“We’ve reached a point where the treatment for opioid addiction is much harder to get than the deadly drugs themselves,” Haney said in a statement. “Dealers are much better at getting fentanyl and heroin into people’s hands than we are at getting them addiction medication. We have to reverse that entirely if we want to save people’s lives.”

For one San Francisco clinic, this change could not come soon enough.

The 6-year-old Bridge Clinic at Zuckerberg San Francisco General Hospital offers addiction treatment for substances including alcohol and stimulants, but about half of its patients struggle with opioid addiction.

The clinic just expanded its hours over the summer, offering in-person afternoon appointments Monday through Friday for patients seeking treatment for addiction. It will do so again next month when it begins offering morning appointments on-site rather than just via telehealth.

Crucially, it’s the only clinic in The City — and one of only a handful in the state — that offers up to three days worth of methadone doses to patients suffering from opioid addictions without being an officially licensed opioid treatment program. The patients can’t yet take those doses home, but will soon be able to under the new state regulations.

“The Bridge Clinic is a clinic that is really focused on making it as easy as possible for people who use drugs to get the medications that can be life-saving for them,” said Dr. Hannah Snyder, the clinic’s director. “We use medications to treat any substance-use disorder, opioids or alcohol or stimulants, anything like that.”

Federal regulators loosened restrictions earlier this year around distributing doses of methadone, which is one of two medications — alongside buprenorphine — that public-health officials are increasingly turning to in order to combat the opioid crisis.

Haney’s legislation moves California’s guidelines on methadone closer to the new federal standard. Before now, only one of San Francisco’s seven licensed clinics — the Opiate Treatment Outpatient Program at San Francisco General — had been able to send patients home with the medication due to a pandemic exception that was extended this year.

The Bridge Clinic is not a licensed opioid treatment program, but Snyder said that the former state guidelines on the medication did not prohibit the Bridge Clinic from giving patients three days of doses in person. Most clinics, she noted, don’t offer this due to administrative challenges of providing methadone.

The Bridge Clinic’s purpose is in its name: Clinicians seek to connect patients seeking opioid-addiction treatment — especially those who find themselves in emergencies — with programs. Around 25% of its patients come to it through the emergency department.

“If a person wants to be on methadone and comes to [Opiate Treatment Outpatient Program] ... and they don’t have enough spots in the morning, they’re all full, those patients can be redirected to the Bridge Clinic, and we can get them started on methadone that day, so that a person isn’t turned away and is able to actually get the services that they need,” she said

On average, the clinic sees two patients per day who are starting methadone treatment but awaiting connection with another programs. Instead of liquid doses, which some patients say they don’t like the taste of, the clinic provides the medication in pill form.

“We have more tools than we had before,” said Alexander Logan, who has worked at the clinic for the last four years. “I would say being able to start methadone in our clinic is a game-changer because, for a lot of folks, methadone is the best tool.”

It’s one that San Francisco public-health officials have increasingly sought to rely upon in the aftermath of last year, The City’s deadliest for drug overdoses since officials started recording data in 2020. While the San Francisco Department of Public Health has removed barriers to buprenorphine access through a variety of methods, expanded access to methadone was harder to attain up until now.

Logan said the inability of the majority of San Francisco clinics to prescribe take-home methadone doses has been a hindrance for patients who say they feel it’s the best option.

“Friday is a tough time to work in the addiction world, because so much of our ability to get people on life-saving treatment depends on our ability to access that treatment that day,” he said. “Right now, if someone comes into my clinic on Friday for whom methadone is the best choice, I can’t do it because I could give you a dose now, but then you’re going to be on your own over the weekend.”

Logan said Haney’s legislation will address this gap, providing patients a safety net outside of traditional clinic hours.

“We frequently start people on methadone in the hospital and get them up to an appropriate dose, and when they leave, that linkage to ongoing care is a fragile moment for them,” he said. “We’ve had lots of people who were able to get on stable on meds in the hospital, and then something goes wrong in that linkage period.”

Ciela Oncina, a substance-use navigator for the clinic who also works with the emergency department at Zuckerberg, said she sees this play out firsthand.

“We want people to get the help they need, and we want to have them feel that they can come to us for help,” she said. “In order to build that trusting relationship with them, we need to be able to offer what we say we can offer.”

Oncina said the looser restrictions will allow other parts of patients’ lives to come into focus once they’re most pressing needs are being met more smoothly.

“Every day we see patients who are struggling with a lot of different things — struggling to find housing, they’re struggling with food insecurity, they have family members that are sick, they have kids that they’re taking care of,” she said. “The list goes on, and on, and on and on.”

Now that the bill has been signed, Snyder said, the clinic has only a few bureaucratic hoops to jump through before they can begin implementing the new standards in a matter of weeks.

“We just need to finish getting all of our paperwork completed,” she said.