Lessons From Maine’s Fight Against Limits on Addiction Treatment

Sharing another opinion........

Maine’s decision to retroactively limit Medicaid payments for buprenorphine to treat opiate addiction is likely to have disastrous consequences, warns the President of the Northern New England Society of Addiction Medicine.
As state budgets continue to tighten, more states are likely to take Maine’s lead, says Mark Publicker, MD. In some states, buprenorphine (Suboxone) and other opiate agonists may not be covered for addiction treatment, while other states are imposing prescribing and refill limits, says Publicker, who is also Medical Director of Mercy Recovery Center in Portland. He is calling on addiction treatment professionals to lead the battle to maintain the availability of medical treatment for addiction.
At the recent American Society of Addiction Medicine (ASAM) annual meeting, Dr. Publicker spoke about the new Medicaid limits on buprenorphine in Maine. He noted patients face a cutoff in medication after a maximum of two years of treatment. The limitations are retroactive, meaning patients on long-term therapy will be hit first and hardest, he said.
“The intent of the new limitations is to save money, but legislators had no concern about the fiscal consequences of such a move, such as increases in crime rates, illnesses, child neglect and an increased number of premature births, which are all anticipated to be far more costly than medications,” he says.
Targeting addiction treatment for budget cuts is an easy move for legislators, he adds. “Addiction is a highly stigmatized condition, and there is no grassroots organization that will rise up to oppose treatment limitations. There is a fundamental misunderstanding about addiction as a chronic disease, and the role of medication in maintenance management.”
Dr. Publicker and colleagues, with the help of ASAM and a number of other medical groups, lobbied against the limits in Maine, but were only able to get a one-year delay in the implementation of the retroactive limit.

“The impact will be disastrous,” he states. “Many of my patients have been on buprenorphine for more than two years, and are leading successful, healthy lives. Many, if not most, of my patients who have achieved sobriety on buprenorphine will go into withdrawal, and the relapse rate will be extremely high. My patients’ lives are at stake.”
In Maine, which is largely rural and poor, opiate addiction is endemic, according to Dr. Publicker. “In many areas, there are no alternatives to medication-assisted treatment. This is a treatment that primary care providers can offer in their offices.”
ASAM is developing a state-by-state survey about the status of buprenorphine limitations, Dr. Publicker notes. At the annual meeting, he urged his colleagues around the country to take action against legislative attempts to cut funding for medication-assisted treatment for addiction.
“The fight against limitations requires coalitions,” he says. “It requires a comprehensive approach involving organizational support and cooperation, effective lobbying, developing personal relationships with legislators and the executive branch, and public information involving the media. It is important to make the clinical case and the economic case against limitations. It is just as important to take this issue to the public, to enlist patients, patients’ families, and other advocacy organizations to join in the fight.”
Drug Free.org

This Mark Publicker is right the consequences of this legislation will be disastrous. Unfortunately, people who matter won't feel the consequences and will use the problems caused by continued active addiction to allow them to justify not treating addiction as the deadly disease it is. I know that Tennessee has already put this type of legislation in place with their medicaid program, and I have seen many people leave the treatment center I go to because their insurance will no longer cover their medications. They know that they're going to relapse and since the law was retroactive when it passed many of them just had to stop then b/c they had already had their two years. If states are going to do this kind of stuff they should at least allow the addict to be treated from the time the law passes instead of grandfathering coverage that occurted before the law changed. At least that way people would know going in that they have x amount of time and could plan accordingly. I'm not saying I agree that it should be limited to a certain amount of time, just that if it is it should be from the start of treatment. I can hear the justification for this ringing in my head...They chose this life so why should taxpayers foot the bill for treatment. They are just replacing one drug with another one anyway. The sad think is that a large part of the recovery community view maintenance medication as just replacing one for another, so addicts can't even use the strength they could have in numbers to fight this type of thing. I just wonder if this restriction will also apply to off label uses of suboxone like for pain relief, b/c if not then providers will skirt the law that way.

I agree completely Monica, this is a disaster waiting to happen. Many more people are going to suffer if this is allowed and other states follow suit.
If they are hell bent on imposing these limits then it should allow for patients who have already been on medication past the two year mark to at least have two more years to allow them to taper off their medication rather than be forced to suddenly stop.
My provider and I talk about this all of the time and she is worried. I'm worried, first medicaid, then medicare, then the private insurers. Just a snowball effect, It won't stop.

You're right, and unfortunately the cost to society in the long run will be much higher than the cost of treatment. But like I said, it's easy to cut addiction treatment b/c we are viewed as second class citizens. We have to work on changing the view of addiction by society at large before we can hope to have addiction and treatment for it be treated as it should be, like any other progressive deadly disease. Right now much of America views addiction as a moral failing rather than a legitimate disease, and the only way to change it is by educating non addicts about the realities of addiction, and by showing society that recovering addicts can be responsible, productive members of society. The thing that really pisses me off is that I could go get pain pills prescribed till doomsday and that wouldn't be an issue, but when I seek to end the cycle of addiction, I'm seen as scum, and even worse I could have methadone, a drug that is commonly used to treat addiction prescribed for pain and no one would bat an eye.

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