A cost-cutting task force is considering a two-year limit on Medicaid coverage for buprenorphine treatment for addiction which would force many current, stable patients to taper off this lifesaving medication within 30 days. Maine’s proposal is especially disturbing when you consider these two very important news releases last month. First, the CDC reports prescription drug overdose deaths are on the rise, with opioid painkiller overdoses accounting for 40 deaths a day nationwide. Second, the largest study to date of Suboxone used for the treatment of prescription drug addiction produced positive results. The study clearly shows that when this effective treatment is discontinued, and thus no longer suppressing the symptoms of addiction, symptoms return placing patients at risk of death from overdose. This confirms that chronic treatment may be appropriate for the chronic condition of addiction. These results will not come as a surprise to medical professionals or patients involved with opioid addiction or buprenorphine treatment, but appear to not even be a consideration of Maine’s task force.
Dr. Mark Publicker, one of 245 Maine physicians who possess the credentials to prescribe buprenorphine for addiction, warns that 90% of his patients will relapse and a significant portion of them will die if Maine carries through and cuts off Medicaid patients. The data supports his warning. The proposal being considered will come into effect retroactively, forcing stable patients in sustained addiction remission for two years or more to begin a 30 day taper.
This kneejerk reaction to cost cutting ignores the evidence and sets the stage for a human disaster. Patients who have been in treatment two years or more are generally stable patients who are benefiting immensely from the treatment, living productive healthy lives and contributing to society. Many are parents who are able to remain in addiction remission and care for their children because of the treatment. Even if the task force ignores the human tragedy, which appears to be the case, the fiscal cost of not treating addiction effectively will far outweigh the savings. Untreated addiction costs society in many ways such as emergency room visits, child services, unemployment compensation, welfare, food stamps, elevated crime, and transmission of disease, i.e. HIV, HEP-C. Not to mention the loss of productivity and tax contributions by those currently able to work because of the treatment. Nobody benefits from cutting off this effective life-saving treatment. If this tragedy is allowed to unfold it might set a precedent and be implemented in more states across the country.
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In what might seem completely contradictory to this proposal Maine recently held a statewide summit on how to reduce drug overdoses, determining that treatment is indeed effective and necessary.
In another twist, it’s also been suggested that patients might be able to get an exemption from the cutoff if the doctor indicates that the treatment is medically necessary. Why is there an assumption that any patients are being prescribed medication that isn’t medically necessary? Only someone with little understanding of addiction or the treatment could make such a proposal. They apparently believe that a significant portion of people being prescribed buprenorphine for opioid addiction by a doctor, don’t need it and the doctor is prescribing it as medically unnecessary. Such a presumption shows the individual does not possess the expertise to be making such life and death decisions about someone’s medical care.
Part of the problem we see in Maine originates with a general and widespread misunderstanding of what addiction is. Despite the last 50 years of evidence, anti-drug propaganda still dominates common perception. Rock solid medical evidence including brain imagery which helps prove addiction is rooted in brain biology is often dismissed in favor of street lore and slogans. This leads to an overly simplistic view of addiction which can be characterized as; the person wants to do drugs with the treatment being; detox/abstinence and the therapy, if any, consisting of; convincing the person drugs are bad. Such ignorance of the condition leads to ineffective treatment and poor results, while effective treatments are seen as perpetuating the problem which they see as drugs, rather than the addiction.
The problem is not drugs, the problem is addiction. In short, addiction is the manifestation of abnormal brain adaptations resulting from chronic drug misuse. Addiction manifests as a behavioral disorder where the patient’s judgment is impaired in the presence of cravings. Detox treatments do not correct these brain adaptations and is why detox treatment alone is notoriously ineffective. What does correct the brain adaptations is a reconditioning process consisting of forming and gaining experience with new healthy patterns of behavior. Buprenorphine suppresses cravings and withdrawal enabling the patients to engage in the reconditioning effort with therapy and behavioral modification. Once this is understood it becomes clear that buprenorphine treatment is necessary until such time that the recondition process has corrected enough of the craving-producing brain adaptations so that remaining symptoms can be managed without medication. That timeframe is primarily dependent on the success of the reconditioning effort and the extent of the abnormal adaptation, not some arbitrary time limit set by bureaucrats.
It all comes down to stigma:
Are treatments for other chronic conditions such as epilepsy, diabetes, hypertension, and depression being considered for rationing at this time? No, because those conditions are more easily recognized as life-threatening chronic medical conditions. The stigma associated with addiction distorts perception allowing for flawed logic. Insert any other chronic medical condition in place of addiction to test the logic and you’ll see just how inhumane this proposal is.
The label of addict carries deep negative stigma. Years of anti-drug propaganda have successfully demonized drugs and the people who use them. The term Addict congers negative feelings of repulsion, anger, filth, and dishonesty. It’s no wonder Maine is having difficulty gathering support for “addicts” by taxpayers, state workers or representatives. “Retard” and “cripple” were once used even within the medical community until people recognized the damage of the attached stigma and changed the language. Until we stop referring to people suffering from addictive disorders as addicts and start referring to them as patients, we will face an uphill battle. The author of this article uses the term addict 9 times. Read it again but replace the word addict with patient and you will see just how the tone changes and emphasizes just how wrong the logic of the rationing proposal is.
Dec 13, 2011 at 10:55 AM Kudos to Dr. Publicker and his allies. They should consider themselves fortunate in some ways, however, because here in Michigan, Medicaid has never approved more than 12 months of buprenorphine therapy for opioid dependent patients except in extenuating circumstances. But they're not even doing that now, cutting people off at 12 months whether they are ready or not. I've had patients relapse and be lost to therapy as a result, and this is tragic. It takes time, usually more than a year, for someone to establish a stable enough recovery for them to taper off this life-saving medication.
Dec 15, 2011 at 9:50 AM It looks like the government would rather kill off those who are unfortunate enough to become addicted to opiates.Which is not a problem for the rich.
In my state bupe has been a miracle.I have lost many friends and neighbors,before bupe became available.
I believe the producers of bupe need to greatly reduce the price,I know they have made a huge profit already.This is truly a miracle life saving medication.
Plus the government should relax its tight control over bupe,because bupe was set up with tight controls to find out how dangerous it was.By now the feds should realize how bupe saves lives and unrestrict the use of bupe to all doctors to prescribe.
Dec 15, 2011 at 4:53 PM This is very tragic. I am writing a book entitled "Pillville" which looks at the real life of addicts here in Eastern Kentucky. One of my goals is to try and change public perception about addiction. Suboxone changed my life. During my research, I have heard many different views on the duration of treatment. The problem of addiction is so bad here that I have had several doctors tell me that they would rather see someone take a suboxone a day for the rest of their lives than to go back to where they were in constant danger. It is clear in any scenario that the benefits far outweigh any negatives. If anyone has any thoughts or would like info about my book, drop me a line at email@example.com
Dec 15, 2011 at 4:58 PM I am a patient in the state of Washington and there are similar limits here already which limit payment of Suboxone treatment to a legth of 6 mos, reqires bi-weekly UA's before picking up the medication at the pharmacy as well as a limit on the daily amount (2-8/2mg. a day. I think this is ridiculous, they will pay for Methadone Maintenence in many places for an indefinite amount of time. I know this medication has saved my life, so I can only Imagine the damage further limits will cause.
Jan 1, 2012 at 10:06 AM I am sickened by what I have just read. I have been on Suboxone for close to 10 years and can say without a doubt it saved my life. There is no doubt that I would in time relapse if I were taken off of it. The benefit far outweighs any risk or $ issue so I have to wonder WHAT ARE THEY THINKING??
Aug 22, 2012 at 7:41 PM I just wanna say everything I just read sickens me also. Suboxone has saved my life PERIOD! I almost lost my wife my family everything dude to abuse. My wife helped me find Suboxone and ever since I have been able to have a normal life with my family and be in my childrens life and activities. It would be horrible if they pulled it off the market. Just my thoughts on the matter. Everyone stay strong and fight.....thats what I do everyday of my life for my KIDS and my WIFE.
Dec 9, 2012 at 7:51 AM I was in and out of the legal system for 32 years and this was all because of my opiate addiction. I tried every way possible to stay drug free. I have been on Suboxone for 5 years and it helped save my life.
Aug 19, 2013 at 3:34 PM This is all terrible. I live in PA and my doctor goes by a very strict timeline. You can start at 2 8/2 suboxone films a day, after 6 months you get weaned to 1.5 and after 6 more months, 1, then .5 after 6 more months. What about the patient? It doesn't matter if I am ready or not and when I mentioned that suboxone was a lifesaver to me plus happens to alleviate some of my depression the doctor got mad and said "it's not an antidepressant or a pain pill" I never said it was, but if it happens to give me the added benefit of helping my depression, why is that bad? I just graduated from college with a degree in psychology and plan on going to grad school and get into substance abuse counseling because I know what it is like. You need to realize each person is unique and cannot be forced (or should not be anyhow) to fall into some nice even 6 month intervals of recovery!